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This case report describes meningitis caused by Stomatococcus mucilaginosus in a previously healthy 2-month-old female infant, believed to be the first such reported case. The patient presented with high fever, seizures, and altered consciousness. Cerebrospinal fluid analysis revealed elevated protein and reduced glucose consistent with bacterial meningitis, with culture isolating S. mucilaginosus from both CSF and blood. The isolate was multidrug-resistant, susceptible only to vancomycin and cefotaxime on initial testing. The patient was initially treated empirically with cefotaxime and amikacin but remained febrile. Vancomycin was added to the regimen, following which the child recovered well without neurological sequelae and was discharged after 12 days. The authors emphasize that S. mucilaginosus, normally part of oral and upper respiratory flora, is increasingly recognized as an opportunistic pathogen. They highlight the organism's increasing antimicrobial resistance over recent decades, with vancomycin emerging as the most reliable therapeutic option. The case is notable for its occurrence in an immunocompetent host, contrasting with prior reports predominantly in immunocompromised or neutropenic patients.

Key findings

• First reported case of S. mucilaginosus meningitis in a healthy child; previous cases occurred in immunocompromised or premature infants
• The isolate was multidrug-resistant but susceptible to vancomycin, which proved clinically effective despite in vitro cephalosporin susceptibility
• S. mucilaginosus has progressively developed antimicrobial resistance over 20 years, with vancomycin now recommended as empiric therapy
• Weak catalase activity and sticky colony morphology with agar adherence are useful identifying characteristics to differentiate this organism from coagulase-negative staphylococci