Relapsed Bacterial Meningitis in an Adolescent Patient with Aberrant Patent Foramen Caecum

Abstract

Bacterial meningitis is a serious life-threatening condition. Recurrent meningitis is defined as two independent episodes of meningitis that are separated by a period of convalescence and full recovery. Therefore, true recurrence results from a re-infection with the same or a different bacterial organism. In contrast, recrudescence and relapsed meningitis (RBM) represent persistence of the initial infection resulting from treatment failure. Both are uncommon and could be due to anatomic anomalies of the skull, traumatic head injury with secondary CSF fistula, complement deficiency or spread from a para meningeal infection.

We present a case of a 13 years old healthy adolescent boy with no significant past medical history, who presented with flu like symptoms and altered mental status. His work up showed Streptococcus pneumoniae meningitis. While receiving effective IV treatment, on day 7 the patient became symptomatic again with fever, vomiting and prostration. Repeat blood tests showed an increase in total white cell count, neutrophils and inflammatory markers. In order to determine the underlying pathology, a repeat CT-scan of head followed by an MRI was done that showed an aberrant patent foramen caecum, that appeared to be the most likely cause of the relapse. This case report illustrates the importance of a search for an anatomical abnormality to be a cause of RBM, even in an adolescent.