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Staphylococcus epidermidis meningitis and an intraspinal abscess associated with a midthoracic dermal sinus tract
S G Gurbani1, C T Cho, K R Lee
1Department of Pediatrics, University of Kansas Medical Center, Kansas City 66160-7330.
Abstract:
Congenital neuroectodermal defects are associated with meningitis that is unresponsive to conventional antibiotic therapy, recurrent bacterial meningitis, or meningitis due to an organism that is not usually the cause of this disease. Midthoracic dermoid and epidermoid cysts occur rarely and are easily overlooked. We report the case of a 13-month-old boy with meningitis that was unresponsive to antimicrobial therapy. We subsequently identified an intraspinal abscess, an infection due to Staphylococcus epidermidis, and a midthoracic dermoid cyst. We emphasize the need for clinicians to have a high index of suspicion and to make a careful physical examination when antibiotic treatment fails in patients with meningitis. We also provide a detailed anatomy of a midthoracic dermoid cyst and illustrate the usefulness of magnetic resonance imaging in preoperative diagnosis of congenital neuroectodermal defects.
Insights
Congenital neuroectodermal defects can cause difficult-to-treat meningitis. A midthoracic dermoid cyst was identified as the cause of recurrent meningitis in a young boy.
Area of Science:
- Neurology
- Pediatrics
- Infectious Diseases
Background:
- Congenital neuroectodermal defects are linked to unusual meningitis presentations.
- Meningitis unresponsive to antibiotics warrants further investigation for underlying causes.
Observation:
- A 13-month-old boy presented with meningitis resistant to standard antimicrobial treatment.
- Diagnostic workup revealed an intraspinal abscess caused by Staphylococcus epidermidis.
Findings:
- A rare midthoracic dermoid cyst was identified as the underlying cause of the recurrent meningitis.
- Magnetic resonance imaging (MRI) proved crucial for preoperative diagnosis.
Implications:
- Clinicians should maintain a high suspicion for congenital defects in refractory meningitis cases.
- Thorough physical examination and advanced imaging like MRI are vital for diagnosing such rare conditions.