A 63-year-old man with non-Hodgkin lymphoma is brought to the emergency department because of fever and confusion that have progressively worsened over the past 3 days. He also has a 3-day history of loose stools. He returned from France 2 weeks ago where he stayed in the countryside and ate typical French cuisine His last chemotherapy cycle was 3 weeks ago. He is oriented to person but not to place or time. His temperature is 39.5°C (103.1°F), pulse is 110/min, and blood pressure is 100/60 mm Hg. cerebrospinal fluid (CSF) analysis showed gram-positive diplococci. He is given dexamethasone followed by systemic antibiotics. Adding dexamethasone most likely benefited from the use of this drug due to which of the following?

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Quizplus · Accepted Answer

Eductional Objective: Pneumococcal meningitis is associated with massive cerebrospinal fluid inflammatory cytokine release in response to bacterial cell wall components.  Treatment with dexamethasone prior to antibiotic therapy has been shown to reduce inflammation and decrease the risk of adverse outcomes (eg, seizures, focal neurologic deficits) and death.  Other forms of bacterial meningitis do not seem to benefit from glucocorticoid treatment.

A 63-Year-Old Man with Non-Hodgkin Lymphoma Is Brought to the Emergency