Streptococcus pneumoniae Meningitis Associated With Over-the-Counter Sinus Irrigation

We present the first reported case of Streptococcus pneumoniae bacterial meningitis that may be associated with use of an over-the-counter sinus irrigation. Sinus rinse or "Neti Pot" use is a common remedy for sinus congestion and is felt to be relatively safe. Given its widespread use, it is important to report possible associations with disease, in this case Streptococcus pneumoniae meningitis. A 50-year-old male with a history of sinusitis presented to the emergency department with a headache and altered mental status and was ultimately diagnosed with Streptococcus pneumoniae meningitis and sepsis. He had been using over-the-counter sinus rinses several times daily with distilled water. The patient had no radiographic evidence of contiguous spread or traumatic injury that would make him susceptible to direct cerebrospinal fluid infection. Inquiring about sinus irrigation use should be considered in patients with suspected meningitis. Emergency clinicians must consider meningitis in patients with Neti Pot use.