Intradural dermoid masquerading as pyogenic meningitis: case report

Area of Science:

• Pediatric Neurosurgery
• Developmental Neurology
• Oncology

Background:

• Intraspinal dermoid tumors are congenital tumors arising from ectopic dermal elements during neural tube closure.
• These tumors are typically found along the midline of the neuraxis, most commonly in the lumbosacral region.
• While often asymptomatic or presenting with neurological deficits like paraplegia or bowel/bladder dysfunction, they can rarely present with atypical symptoms.

Observation:

• A 3-year-old boy presented with signs suggestive of meningitis, including fever, nuchal rigidity, and irritability.
• Initial diagnostic workup focused on infectious causes, leading to a presumptive diagnosis of pyogenic meningitis.
• Further investigation revealed an intradural mass, which upon surgical resection and histopathological examination, was confirmed as a dermoid tumor.

Findings:

• The intradural dermoid tumor in this pediatric patient presented with meningeal signs, a highly unusual clinical manifestation.
• This presentation mimicked pyogenic meningitis, underscoring the importance of considering rare neoplastic etiologies in pediatric neurological emergencies.
• The tumor's location and presentation highlight the diverse clinical spectrum of intraspinal dermoid tumors.

Implications:

• This case expands the known clinical spectrum of intraspinal dermoid tumors, emphasizing that meningeal signs can be a presenting feature.
• It underscores the diagnostic challenge posed by dermoid tumors that masquerade as more common pediatric conditions like meningitis.
• Early recognition and consideration of intraspinal tumors in the differential diagnosis of pediatric meningitis are crucial for timely and appropriate management.