[Early lumbar puncture and cutaneous rash: a clear CSF is not always a normal CSF].
The clinical and biological characteristics of adult bacterial meningitis are usually unequivocal, but more subtle clinical presentations can be observed. A 24-year-old woman was admitted with fever and abdominal discomfort, which had been developing for 24 hours. There were no meningeal signs, but a transient cutaneous rash was observed on admission. A clear CSF was obtained showing no cytological or biochemical abnormality. Ceftriaxone 2 g was administrated intravenously. In the following hours of admission, a frank meningeal syndrome with purpura appeared, leading to a second lumbar puncture, which revealed purulent CSF. The culture of the first CSF yielded Neisseria meningitidis, while the second CSF remained sterile. This case showed a probable meningococcal rash. This is a reminder that a normal CSF can be obtained early in the course of a proved bacterial meningitis, and that CSF bacterial eradication can occur very rapidly after a single dose of third-generation cephalosporin.
Rebeu-Dartiguelongue
Isabelle
I
Département Samu SMUR urgences réanimation, unité des urgences, centre hospitalier du Val-d'Ariège, B.P. 01, 09017 Foix cedex, France.
Laurent
Jean-Pierre
JP
Clarac
Annie
A
Vergne
Sylvie
S
Avedan
Marc
M
Alzieu
Marc
M
Campistron
Jean
J
D015746:Abdominal Pain / Q000209:etiology; D000328:Adult; D002443:Ceftriaxone / Q000627:therapeutic use; D002555:Cerebrospinal Fluid / Q000382:microbiology*; D005076:Exanthema / Q000209:etiology*; D005260:Female; D005334:Fever / Q000209:etiology; D006801:Humans; D008585:Meningitis, Meningococcal / Q000134:cerebrospinal fluid* / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology; D009345:Neisseria meningitidis / Q000302:isolation & purification*; D013129:Spinal Puncture
D002443:Ceftriaxone