Meningococcic meningitis complicated with brain abscess in young infant - Case report

Abstract

Introduction: Meningococcal disease has high morbidity and lethality. Its main manifestation is meningitis, with fever, myalgia, nausea and vomiting, irritability, neck stiffness and hemorrhagic rash that may evolve with neurological complications. A case of uncommon presentation in a young infant with complicated meningococcal meningitis will be reported. Case Report: A previously healthy 1-month-old infant with fever for three days and abdominal pain was admitted to the intensive care unit in septic shock, sedated, intubated, receiving amines and empirical antibiotic therapy, presenting right eyelid ptosis and bulging fontanelle. Meningococcus in CSF was identified by molecular technique. Despite adequate ceftriaxone therapy, he maintained complex seizures, thermal lability and cerebrospinal fluid changes, biochemistry, and positive meningococcal PCR in serial analyzes. Cranial computed tomography showed right temporal abscess, drained by neurosurgery, with subsequent clinical and cerebrospinal fluid improvement. She received ceftriaxone antibiotic therapy for 31 days, and meropenem and vancomycin for 14 days, for treatment of postoperative pneumonia. In the evaluation of neurological sequelae, bilateral optic nerve pallor in the fundus was identified. Discussion: Proper management of children with meningococcal disease is of paramount importance for the clinical outcome. It is imperative that pediatricians suspect meningococcal disease in an acute febrile condition, especially in young infants, allowing early institution of appropriate therapy and thus reducing their morbidity and mortality. Neurological complications should be suspected in the persistence of fever after treatment or in the presence of focal neurological signs or altered level of consciousness.