A 9-month-old male with a 3-day history of fever, emesis*
A 9-month-old male presented to the ED with a 3-day history of fever up to 104°F, emesis, decreased urine output and a weak cry with fatigue. He was seen by his primary 1 day earlier, and with a normal chest radiograph, he was diagnosed with a viral illness. It is noted that he had a brief hospitalization 2 weeks earlier for bronchiolitis.
His past medical history was significant for being a 26-week, premature quintuplet, with a 4-month NICU stay, complicated by a grade II intraventricular hemorrhage and GERD, but not chronic lung disease.
Examination in the ED found the baby to be somewhat lethargic with a weak cry, and with a bluish lacy appearance to the skin and prolonged capillary refill, consistent with shock. A partial sepsis workup was done, including blood and urine cultures, CBC, comprehensive metabolic panel, INR and UA, revealing thrombocytopenia and a coagulopathy suggestive of sepsis.
A chest radiograph revealing bilateral lung consolidation and a normal head CT were also obtained. The patient was given fluids and antibiotics (vancomycin plus ceftriaxone), and transferred to the PICU.
He soon began having seizures, apnea and purpura of the extremities, and was intubated for ventilatory support. His lumbar puncture around that time revealed a cell count of 20 WBCs (40% segs) and 100 RBCs, protein 805, glucose of 0, and a Gram stain revealing Gram-positive cocci. Within a few hours of arriving to the PICU, his blood and cerebrospinal fluid (CSF) cultures were being reported positive for Gram-positive cocci in pairs and chains.
What’s your diagnosis (cause)?
A. Neisseria meningitidis
B. Group B streptococcus
C. Streptococcus pneumoniae
D. Listeria monocytogenes
Answer to be disclosed shortly!
*Note: The present case appears in Healio