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Rebekka Kohlmann, Andrey Nefedev, Martin Kaase, Sören Gatermann

• \(\bf Background:\) \(\textit {Escherichia coli}\) is a rare cause of community-acquired meningitis in adults unless predisposing factors are present (e.g., previous penetrating cranio-cerebral injury or neurosurgery, immunosuppression, chronic alcoholism, history of cancer, diabetes mellitus, advanced age). \(\textbf {Case presentation:}\) We describe the case of a 53-year-old woman, resident in Germany, suffering from community-acquired bacterial meningitis caused by CTX-M-9 type extended spectrum \(\beta\)-lactamase producing \(\textit {Escherichia coli}\). Because typical predisposing factors were not apparent, pathogen identification resulted in expanded diagnostics to exclude a distant or contiguous primary focus. By magnetic resonance tomography, a previously unrecognized large retropharyngeal abscess with cervical spondylodiscitis was detected. In retrospect, the patient had complained about neck pain for a few weeks prior to meningitis onset, but the symptoms were interpreted as being related to a herniated disk. Meningitis and osteomyelitis resolved completely under surgical treatment and meropenem therapy. \(\bf Conclusion:\) In case of adult \(\textit {Escherichia coli}\) meningitis, underlying diseases should always be carefully excluded, especially if predisposing factors are not apparent.