Neisseria meningitidis is the leading cause of bacterial meningitis in children and young adults. Extrameningeal manifestations of Neisseria meningitidis infection are uncommon in normal children and are a consequence of invasion of the bacterium into the blood stream. We describe a case of IMD with meningoencephalitis, septic arthritis, myositis and pleural effusion who developed secondary fever and prolonged hospitalization.
Case report: A 10-year-old boy previously healthy was referred from a local hospital for suspected bacterial meningitis. He had a two-day history of neck stiffness, fever, drowsiness, vomiting and neck stiffness. His Glasgow Coma Scale score was 13/15, (E4V4M5), with neck stiffness, drowsiness and disorientation. There were no skin rash or respiratory symptoms. A brain CT-scan was normal. Attempt to perform a lumbar puncture failed and cefotaxime was started after taking a blood culture before initiating transport.
On admission to our hospital, the patient had a temperature of 37,8ºC, blood pressure of …show more content…
His symptoms gradually improved over the course of 10 days, but a daily spike in temperature persisted despite ketorolac treatment. The patient was asymptomatic without dyspnea or chest pain, and saturation rate was over 98% but a Chest x-ray showed mild pleural effusion. Echocardiography ruled out cardiological involvement. Other etiologies of seconday fever such as phebitis and urinary tract infections were ruled out and serial blood cultures were negative
After 21 days of cefotaxime treatment with continuing fever and high reactants, patient developed anemia, leukopenia with positive direct Cooms test. Drug fever was suspected and antibiotic was discontinued. Fever resolved within 24 hours of the withdrawal of cefotaxime but mild temperature remained thereafter. Prednisone was then started with a rapid return of the temperature to
Case report: A 10-year-old boy previously healthy was referred from a local hospital for suspected bacterial meningitis. He had a two-day history of neck stiffness, fever, drowsiness, vomiting and neck stiffness. His Glasgow Coma Scale score was 13/15, (E4V4M5), with neck stiffness, drowsiness and disorientation. There were no skin rash or respiratory symptoms. A brain CT-scan was normal. Attempt to perform a lumbar puncture failed and cefotaxime was started after taking a blood culture before initiating transport.
On admission to our hospital, the patient had a temperature of 37,8ºC, blood pressure of …show more content…
His symptoms gradually improved over the course of 10 days, but a daily spike in temperature persisted despite ketorolac treatment. The patient was asymptomatic without dyspnea or chest pain, and saturation rate was over 98% but a Chest x-ray showed mild pleural effusion. Echocardiography ruled out cardiological involvement. Other etiologies of seconday fever such as phebitis and urinary tract infections were ruled out and serial blood cultures were negative
After 21 days of cefotaxime treatment with continuing fever and high reactants, patient developed anemia, leukopenia with positive direct Cooms test. Drug fever was suspected and antibiotic was discontinued. Fever resolved within 24 hours of the withdrawal of cefotaxime but mild temperature remained thereafter. Prednisone was then started with a rapid return of the temperature to