Atypical Presentation of Meningoencephalitis in an Infant Caused by Meningococcemia and Complicated by Ventriculitis with Bilateral Extra Axial Septated Collection

Abstract

Background: The diagnosis of meningitis in the infancy period is a challenging. Clinical evaluation and high index of suspicion with early empirical treatment guidelines continue to evolve and support physician efforts to decrease the morbidity and mortality associated with pediatric meningitis. Case report: We report a case of a previously healthy 2-month-old male who presented with excessive crying, preceded by subjective fever and watery diarrhea, for one day without any other symptoms. Parents gave multiple antipyretic doses at home for irritability which might mask his fever. The patient was tachycardic with an unremarkable physical exam. Full septic work-up done after stabilization of the patient and empirical antibiotics started. His blood culture grew Neisseria meningitides which caused meningoencephalitis and ventriculitis with bilateral extra-axial collection, the patient was in septic shock with multiple organ dysfunction. Conclusion: Meningococcal meningitis in the neonatal and infancy periods remains a serious health threat with high morbidity and mortality. This case report urges the physician to keep a high index of suspicion by taking detailed history and frequent assessment in each suspected cases as the clinical presentations, signs and symptoms in the infancy period are not specific nor classic to guide the physician.