Charles Hwang, MD and Carolyn Holland, MD, MEd

UF Health

Department of Emergency Medicine

A previously healthy, unvaccinated 10-month-old boy presented to the emergency department with a 3-day history of fatigue and somnolence.  Examination revealed an obtunded infant with sluggish pupils, bulging anterior fontanelle, bradycardia, hypertension, and extensor posturing with no purposeful movement.  His workup revealed a white blood cell count of 50.6 x 10³ mm^-3, bandemia of 8%, and hyponatremia of 119 mmol L^-1.  A computed tomographic (CT) scan (Figure 1) of his brain showed hydrocephalus with fluid levels in bilateral ventricles with debris within the cerebrospinal fluid (CSF).  He was started on broad-spectrum antibiotics, and an external ventricular drain was placed.  CSF studies demonstrated WBC 905 mm^-3, RBC 21 mm^-3, glucose < 2 mg dL^-1, protein 302 mg dL^-1.  CSF culture confirmed Neisseria meningitidis.  Magnetic resonance imaging (MRI) (Figure 2) of the brain showed severe, diffuse meningitis and ventriculitis with purulent accumulation in the ventricles, sulci, and cisterna magni. read more