SHM Converge Scientific Abstract ePoster Gallery-Recurrent Meningitis Is More Than It Appears, Check the Ears

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A 4-month-old unvaccinated male presented with left-sided weakness, decreased activity, and signs of right MCA stroke. Workup showed leukocytosis, microcytic anemia, thrombocytosis, and lumbar puncture positive for <em>Haemophilus influenzae</em>, consistent with complicated meningitis and stroke. Audiology later confirmed right-sided sensorineural hearing loss. He completed 28 days of ceftriaxone and vancomycin.

At 6 months of age, he returned with fever, irritability, vomiting, and staring spells, again with left-sided weakness and spasticity. Although CSF studies were negative this time, inflammatory markers were elevated and empiric antibiotics were restarted. MRI then revealed a right cochleovestibular malformation involving the membranous labyrinth, and CT temporal bones confirmed an abnormal right inner ear with an incomplete cochlear partition and only 1.5 turns, suggesting communication between the subarachnoid space and the middle ear.

The case highlights recurrent meningitis caused by a congenital inner ear malformation, specifically Mondini dysplasia. This defect creates an abnormal connection that allows retrograde spread of infection, predisposing to meningitis. Recurrent meningitis in the setting of hearing loss should prompt temporal bone CT to look for structural ear abnormalities. The report emphasizes that recurrent meningitis can lead to significant mortality and neurodevelopmental injury if not recognized early. Definitive management may include cochlear implantation.

Asset Subtitle

Silvia Carolina Escudero

Meta Tag

Author List Christina Perez-Arche, Daniela A. Ramirez, Maria Daniela Godoy, Melissa C. Clemente, Silvia Carolina Escudero, Stephanie A. San Martin

Category Clinical Vignettes

Concept Recurrent Aseptic Meningitis

Concept Temporal Bone CT

Concept Congenital Inner Ear Malformation

Concept Mondini Dysplasia

Concept Hearing Loss

Distinguished Non-Finalist

Presenter Organization Nicklaus Children's Hospital

Presenting Author Silvia Carolina Escudero

Track Pediatric

Keywords

recurrent meningitis

Mondini dysplasia

congenital inner ear malformation

Haemophilus influenzae

sensorineural hearing loss

right MCA stroke

temporal bone CT

cochleovestibular malformation

cochlear implantation

pediatric infection

Recurrent Aseptic Meningitis

Temporal Bone CT

Congenital Inner Ear Malformation

Mondini Dysplasia

Hearing Loss