Dermal sinus tract - An OFT overlooked cause of E. coli meningitis

Abstract

Sir, Recurrent meningitis in children is a serious problem, more so if the causative organism is not a common cause of meningitis. Several factors may have to be considered in the etiology of recurrent meningitis like immunocompromised state HIV positive state. An important cause of recurrent meningitis which can be overlooked is a dermal sinus tract which may cover the spine or even the cranium. We have encountered a case of dermal sinus (DST) tract which was a source of meningitis. We wish to highlight this as an important cause of meningitis particularly if it is recurrent. A 1-year-3 month old developed normally female child first born to nonconsanguineous parents , was brought for the complaints of high grade intermittent fever and vomiting of 5 days duration and recent onset of left eye squint. No other focal neurologic deficit was present. Clinical impression at the time of admission was acute intracranial infection. Examination of the back revealed the opening of dermal sinus tract and a surrounding flat hemangioma in the lumbosacral region. The initial CT scan of the brain was normal and CSF analysis was suggestive of pyogenic meningitis. (more than 100 WBC/HPF, neutrophils – 98%, lymphocytes - 2%, proteins – 450mg/dl, sugar - 3mg/dl, chloride 110 mmol/l). Pending CSF culture, she was started on ceftriaxone and vancomycin. Vancomycin was added to cover gram-positive organisms in view of the DST. CSF culture grew extended spectrum beta lactamase (ESβL) E. coli. Over the next 48 hrs her sensorium deteriorated and a MRI of the brain was done, which showed hydrocephalus. An external ventricular