Case Report: A 5-month-old previously healthy, adopted African-American female presented to her pediatrician with a one-week history of fever, increased fussiness, and diarrhea. Exam revealed bulging fontanelle concerning for meningitis. She was transferred to the Emergency Department (ED) for sepsis evaluation. Her initial exam revealed an ill-appearing, but non-toxic infant with tachycardia, grunting and tachypnea. Anterior fontanelle was bulging, but non-pulsatile. Initial work up revealed a CBC with leukocytosis and neutrophil predominance along with normocytic anemia. CSF studies were concerning for bacterial meningitis with CSF pleocytosis. She was started on empiric antibiotics and on hospital day 2 CSF cultures grew Pasteurella multocida (P. Multocida). An MRI showed findings consistent with meningitis, but also osteomyelitis of the C3 vertebra. Despite multiple days of antibiotic therapy, she remained febrile and showed worsening pain with movement of the neck and extremities. A repeat MRI was performed and was concerning for septic arthritis of both hips and the right elbow; however, surgical aspiration of all joints revealed frank blood. Work-ups for coagulopathy and immune complex-mediated arthropathy were performed and resulted normal. Following a full course of antibiotic therapy in addition to ibuprofen for presumed reactive arthritis the patient dramatically improved until discharge to a short-term rehabilitation program. Discussion: P. multocida is a small, encapsulated, coccobacillus that is found as part of the commensal oral flora in animals. Although most commonly presenting as skin infections in humans, P multocida has been reported as a rare cause of meningitis in the pediatric population, and children < 1 year of age are at particular risk. Transmission due to P. multocida is most commonly due to direct contact with animals, horizontal transmission from caregiver, or vertical transmission during delivery. We present an infant with P. multocida C3 osteomyelitis and meningitis complicated by oligoarticular hemarthrosis likely secondary to non-traumatic contact with her pet. Findings of C3 osteomyelitis and meningitis are exceedingly rare and have only been described once in a pediatric patient by Hirsh, et al. To our knowledge, this is the first case of C3 osteomyelitis and meningitis with complications of oligoarticular hemarthosis described in a patient with P. Multocida. This case provides a unique opportunity to educate the community on appropriate interactions of our pediatric population with animals including pets. Emphasis should be placed on educating families on adequate hand hygiene after any family member touches a pet to prevent horizontal transmission and infant contact with animal saliva should be avoided.
A Case of Pasteurella Meningitis with c3 Osteomyelitis Complicated by Oligoarticular Hemarthroses in a 5-month-old
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Allison K. Black, Raafia Tariq, Ryan Eid, Alexandra Healy, Nate Nessle, Amy Holthouser; A Case of Pasteurella Meningitis with c3 Osteomyelitis Complicated by Oligoarticular Hemarthroses in a 5-month-old. Pediatrics January 2018; 141 (1_MeetingAbstract): 689. 10.1542/peds.141.1MA7.689
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