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.