A Case of Meningitis? What’s Your Diagnosis?

The five year old, somnolent girl from Mozambique with no medical history was presented with fever, neckstiffness, headaches, an almost complete paraplegia and a septic picture. Malaria parasites and HIV testing was negative. The lumbal puncture revealed staphylococcus. Subsequently a MRI scan showed no sign of meningitis but an extensive posterior epidural collection from C3 to the level of S1. Moreover it showed a vertebral osteomyelitis at L1. Bacteria in CSF were seen as an artefact and the child was treated by multilevel (purely) epidural punctures with drainage, rinsing and instillation of ceftriaxon. The epidural puncture proved acid fast bacilli in the pus, so that an anti-tuberculotic therapy was given. The child recovered quickly from sepsis and was able to walk several steps without help after three months.