DOI: https://doi.org/10.36347/sjmcr.2025.v13i11.048

Pages: 2862-2865

Bacterial meningitis remains a major cause of intensive care admissions, yet its presentation may be misleading when associated with concomitant metabolic or infectious disorders. We report the case of a 60-year-old woman with no prior medical history, admitted for inaugural diabetic ketoacidosis associated with a febrile meningeal syndrome. Cerebrospinal fluid (CSF) analysis supported a diagnosis of bacterial meningitis, prompting urgent antibiotic therapy combined with intensive management of the metabolic derangement. Although initial evolution was favorable, persistent fever and neck stiffness prompted cervicothoracic imaging, which revealed stern costoclavicular osteoarthritis complicated by a deep abscess and infectious myositis of the sternocleidomastoid muscle. This case underscores the importance of systematic reassessment in patients with incomplete clinical response to antibiotic therapy and highlights how rare infectious localizations may mimic or complicate a meningeal syndrome, particularly in the setting of severe metabolic disturbances.