Posterior fossa dermoid cyst with sinus tract and meningitis in a toddler.
Intracranial dermoid cysts are rare, but can cause recurrent bacterial or aseptic meningitis, abscesses or mass effect. We describe a toddler who manifested an occipital "lump" for 6 months without further evaluation. He presented with lethargy and meningitis. A posterior fossa dermoid cyst with a sinus tract was detected by imaging studies. He underwent prompt surgical excision of the cyst and the sinus, and received a prolonged course of antibiotics, because anaerobes were isolated from the contents of the cyst and blood. His postoperative course was complicated, and required the placement of a lumboperitoneal shunt. A high index of suspicion for the detection of dermoid cysts is required when a congenital midline skin lesion such as a dimple or a scalp swelling is reported. Prophylactic excision is indicated to prevent serious sequelae.
Division of Infectious Diseases, Department of Pediatrics, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York 10467, USA. mdouvoyi@montefiore.org
Miltiadis
M
Douvoyiannis
David L
DL
Goldman
Ira R
IR
Abbott
Nathan
N
Litman
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001421:Bacteria, Anaerobic; D003392:Cranial Sinuses / Q000473:pathology*; D003884:Dermoid Cyst / Q000150:complications* / Q000473:pathology* / Q000601:surgery; D006801:Humans; D007223:Infant; D015192:Infratentorial Neoplasms / Q000150:complications* / Q000473:pathology* / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D008581:Meningitis / Q000150:complications* / Q000382:microbiology; D008795:Metronidazole / Q000627:therapeutic use; D019635:Neurosurgical Procedures; D014640:Vancomycin / Q000627:therapeutic use
D000900:Anti-Bacterial Agents; D008795:Metronidazole; D014640:Vancomycin