Abstract
BackgroundBacterial meningitis is a medical emergency, and immediate diagnostic steps must be taken to establish the specific cause. Recurrence of bacterial meningitis in children is not only potentially life-threatening, but also involves or induces psychological trauma to the patients through repeated hospitalization with many invasive investigations.Case presentationA 6-year-old boy was diagnosed with recurrent bacterial meningitis caused by Streptococcus Pneumonia 23 F. He had received serial imaging studies for identifying the cause. The initial sinus computed tomography (CT) also showed sinusitis without bony defect of sinus. However, after performing nuclear scan, the results showed cerebrospinal fluid (CSF) leaked originating from the right petrooccpital region into the middle ear. Subsequent high resolution CT (HRCT) reports showed focal enlargement of the right facial nerve canal, erosion of the bony canal at geniculate ganglion and tympanic segment with tiny high-density spots. The reconstruction HRCT showed multiple bony defects at temporal bone. The magnetic resonance imaging revealed multifocal bony destruction with CSF collection in the right petrous ridge, carotid canal and jugular foramen. Eventually, CSF leakage to the right middle ear was confirmed and this could be the cause of the recurrent bacteria meningitis in this patient.ConclusionAlthough recurrent bacterial meningitis in childhood is not common, this case report illustrates that recurrence of meningitis within a short period should be considered as cause of underline immunologic or anatomic defect.
Highlights
Bacterial meningitis is a medical emergency, and immediate diagnostic steps must be taken to establish the specific cause
Conclusion: recurrent bacterial meningitis in childhood is not common, this case report illustrates that recurrence of meningitis within a short period should be considered as cause of underline immunologic or anatomic defect
We present the case of a 6-year-old boy with repeated bacterial meningitis within 6 months and further imaging exanimations proved the cause of cerebrospinal fluid (CSF) leakage originating from the right petrooccpital region into the middle ear
Summary
Bacterial meningitis is a medical emergency, and immediate diagnostic steps must be taken to establish the specific cause so that appropriate antimicrobial therapy can be initiated [1, 2]. We present the case of a 6-year-old boy with repeated bacterial meningitis within 6 months and further imaging exanimations proved the cause of CSF leakage originating from the right petrooccpital region into the middle ear. The gram stain of CSF showed Sptreptococcus Pneumoniae (Fig. 1), and antibiotics with vancomycin and cefotaxime were given immediately. Based on the report of the sensitivity to antibiotics in the strain of 23 F, vancomycin was useful and given continuously for 14 days To trace back his past history, about 6 months ago, this pediatric patient suffered from bacterial meningitis, and was admitted for survey and treatments. CSF leakage to the right middle ear was confirmed and this may explain the cause of the recurrent bacteria meningitis in this boy. After complete antimicrobial treatments with vancomycin for 14 days, this patient was discharged home, and received conjugated streptococcus pneumoniae vaccination (Prevenar 7) by self-payment, which is not included in the program of our national schedule vaccination at that time
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