A 2-MONTH-OLD boy presented with a 7-day history of fever. Despite antibiotic therapy for pharyngitis, his fever persisted and he started to vomit and became irritable. On 2 occasions, the mother noticed short myoclonic contractions of the left arm and leg .
Medical history includes a fever on the second day of life, attributed to viral gastroenteritis.
Physical examination showed an irritable infant with macrocephaly (head circumference, 42.5 cm; 97th percentile, 42 cm) and gray, poorly perfused skin. The anterior fontanel was bulging and his eyes demonstrated a sunset sign. He lay spontaneously with his neck extended. The peripheral blood showed a white blood cell count of 24.9× 109/L. The blood culture was sterile. Results of a lumbar puncture and analysis of the cerebrospinal fluid showed a white blood cell count of 4.3×109/L, a protein concentration of 226 g/L, and a glucose concentration of less than 0.5 µmol/L (<10 mg/dL). No bacteria were detected microscopically. The cerebrospinal fluid culture was sterile.
Cranial ultrasonography and cranial computed tomography were performed (Figure 1). Figure 2 shows a computed tomographic scan after 10 weeks of antibiotic therapy.
Bruneel E, Gillis P, Raes M, Donkersloot P, Duyvendak H, Alliet P, Wood BP. Radiological Case of the Month. Arch Pediatr Adolesc Med. 1998;152(3):297–298. doi:10.1001/archpedi.152.3.297