A first psychotic episode is a diagnostic challenge that makes it necessary to exclude organic causes of neurological nature. Encephalitis is the first etiology to be considered, with infectious and autoimmune conditions being the most prominent. Streptococcus pneumoniae infection in the central nervous system (CNS) usually presents as acute meningitis. Cortical symptoms in that type of infection are unusual, and psychiatric symptoms are remarkable findings. If they occur, they usually improve with appropriate antibiotic treatment or remain as long-term neurological sequelae. We present the case of a patient with subacute psychiatric symptoms associated with confirmed S. pneumoniae meningitis, with no improvement with the use of antibiotics or antipsychotics, and with a response to immunosuppressants.