This case is an example of a bacterial myelitis, which is an uncommon complication of pneumococcal meningitis.

Cord involvement in pneumococcal meningitis can be due either to infective myelitis or vascular compromise related to vasculitis, vasospasm or septic shock.  In this case two features strongly favoring bacterial myelitis were the distribution of cord abnormality (not typical of ischemia) and the near complete resolution of cord changes on follow-up imaging.