Bacterial meningitis in patients with multiple myeloma: a prospective nationwide cohort study and review of the literature

Objectives: To study the clinical features of bacterial meningitis in patients with myeloma. Methods: We analyzed patients with myeloma who were included in a nationwide cohort of patients >16 years old with community-acquired bacterial meningitis in the Netherlands from 2006 to 2018. Subsequently, we reviewed the literature for articles reporting patients with myeloma with bacterial meningitis. Results: A total of 27 of 2306 episodes (1.6%) of bacterial meningitis occurred in patients with myeloma. Six of 27 patients (22%) underwent stem cell transplantation. Median cerebrospinal fluid (CSF) leukocyte count was 172/µl, and 12 of 26 patients (46%) had a CSF leukocyte count <100/µl. Streptococcus pneumoniae was the causative pathogen in 25 patients (93%). Fourteen patients (52%) had unfavorable outcomes, of whom 10 (37%) died. Ninety-one patients with myeloma with bacterial meningitis were described in the literature. The most common pathogen in these patients was S. pneumoniae (35 of 48; 73%) and four (20%) of 20 patients died. Conclusion: Bacterial meningitis in patients with multiple myeloma is a severe disease with high rates of unfavorable outcome. Patients often present with a lower CSF leukocyte count than patients with bacterial meningitis without multiple myeloma. Physicians should set a low threshold to perform lumbar puncture in patients with myeloma and start antibiotic treatment pending CSF chemistry and culture results.