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Refractory status epilepticus due to pneumococcal meningitis in an infant with congenital immunodeficiency
Sudhakaran Prasanth1, Velayudhan Cheruvallil Shaji1, Chacko Lyla2
1Department of Neurology, TD Medical College, Alappuzha, Kerala, India.
Insights
Pneumococcal meningitis can present with severe seizures. In infants, refractory status epilepticus may indicate an underlying immunodeficiency, such as complement factor C3 deficiency.
Area of Science:
- Pediatric Neurology
- Infectious Diseases
- Immunology
Background:
- Pneumococcal meningitis is a severe infection with diverse clinical manifestations.
- Refractory status epilepticus in infants poses a significant diagnostic and therapeutic challenge.
Observation:
- A 3-month-old infant with pneumococcal meningitis developed refractory status epilepticus despite standard treatments.
- The infant had a history of a neck abscess, suggesting a potential underlying condition.
Findings:
- Despite broad-spectrum antibiotics, the infant's condition progressed, prompting further investigation.
- Deficiency in complement factor C3 was identified as the underlying immunodeficiency.
Implications:
- This case highlights the importance of considering congenital immunodeficiencies in infants with severe bacterial meningitis and refractory seizures.
- Cerebrospinal fluid analysis showing numerous bacteria and few neutrophils may suggest an underlying immune defect.
Abstract:
Pneumococcal meningitis remains a life-threatening infection, with varied presentations. A 3 month-old-baby with pneumococcal meningitis presented with clusters of seizures evolving into refractory status epilepticus despite standard antibiotic and aggressive anticonvulsant therapy. Progressive illness despite antibiotic initially suggested possible antibiotic resistance and resulted in addition of another antibiotic. Nonresponse to standard treatment and previous history of abscess in the back of neck pointed to some underlying congenital immunodeficiency. Further evaluation showed a deficiency of complement factor C3. This case underlines the need to consider underlying immunodeficiency in cases of refractory status epilepticus due to bacterial meningitis. Gram-staining of cerebrospinal fluid sample showing plenty of Gram-positive bacteria and comparatively fewer pus cells is a clue regarding some underlying immunodeficiency.
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