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.
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