Cerebral Vasculitis in a Pediatric Staphylococcal Meningitis: A Case Report

Abstract

Background: Cerebral vasculitis is a dreadful complication of bacterial meningitis leading to significant morbidity and mortality. Pathology behind this complication can be attributed to intra-arterial thrombosis, arteritis and vasospasm. We report our experience of cerebrovascular complication in staphylococcal meningitis in an 11 month old female child. Case Presentation: 11 month old previously healthy female child presented with fever and multiple episodes of seizure. After initial stabilization child was found to have bacterial meningitis which later found to be caused by Staphylococcus aureus. MRI brain was suggestive of acute infarcts and MR angiography showed ICA occlusion affecting both sides. She was treated with sensitive antibiotics, IVIG and aspirin. Child showed marked clinical improvement and discharged in good health and presently on regular follow up. Conclusion: Although few cases of cerebral vasculitis in bacterial meningitis have been reported before, community acquired staphylococcal meningitis complicating with central nervous system vasculitis in pediatric age group is a rarity. Similarly there is no evidence base recommendation in treating cerebral vasculitis associated with severe bacterial infection with sporadic reports of effectiveness of high dose IV methylprednisolone, IVIG, immunosuppressive therapy etc. Keyword: Bacterial meningitis, Staphylococcus aureus, CNS vasculitis, Magnetic resonance Angiography (MRA), Immunoglobin (IVIG), Aspirin, Methyl prednisolone. Introduction CNS vasculitis in children can be primary or secondary to underlying infectious, immunological or collagen vascular diseases [1] . Cerebro-vascular complication in bacterial meningitis is a rare dreadful condition seen in 925% of cases [2] . They may present with intractable seizures, cognitive deficit, cranial nerve involvement, weakness or other focal neurological deficit. Community acquired staphylococcal meningitis is a rare entity in itself and can cause neurological complications leading to high www.jmscr.igmpublication.org Index Copernicus Value: 79.54 ISSN (e)-2347-176x ISSN (p) 2455-0450 DOI: https://dx.doi.org/10.18535/jmscr/v7i5.116