title: Recurrent Streptococcus Pneumoniae 23 F meningitis due to cerebrospinal fluid leakage from the ear cannel: a case report.
abstract: BACKGROUND
  Bacterial meningitis is a medical emergency, and immediate diagnostic steps must be taken to establish the specific cause. Recurrence of bacterial meningitis in children is not only potentially life-threatening, but also involves or induces psychological trauma to the patients through repeated hospitalization with many invasive investigations.
  
  
  METHODS
  A 6-year-old boy was diagnosed with recurrent bacterial meningitis caused by Streptococcus Pneumonia 23 F. He had received serial imaging studies for identifying the cause. The initial sinus computed tomography (CT) also showed sinusitis without bony defect of sinus. However, after performing nuclear scan, the results showed cerebrospinal fluid (CSF) leaked originating from the right petrooccpital region into the middle ear. Subsequent high resolution CT (HRCT) reports showed focal enlargement of the right facial nerve canal, erosion of the bony canal at geniculate ganglion and tympanic segment with tiny high-density spots. The reconstruction HRCT showed multiple bony defects at temporal bone. The magnetic resonance imaging revealed multifocal bony destruction with CSF collection in the right petrous ridge, carotid canal and jugular foramen. Eventually, CSF leakage to the right middle ear was confirmed and this could be the cause of the recurrent bacteria meningitis in this patient.
  
  
  CONCLUSIONS
  Although recurrent bacterial meningitis in childhood is not common, this case report illustrates that recurrence of meningitis within a short period should be considered as cause of underline immunologic or anatomic defect.
authors.affiliation: Department of Pediatrics, Taichung Tzuchi Hospital, the Buddhist Medical Foundation, Taichung, Taiwan, R.O.C. applehouse456@yahoo.com.tw.
authors.forename: Yu-Cheng
authors.initials: YC
authors.lastname: Li
authors.affiliation: Division of Emergency Medicine, Department of Pediatrics, Changhua Christian Hospital, Changhua, Taiwan, R.O.C. 116984@cch.org.tw.|School of medicine, Chung Shan Medical University, Taichung, Taiwan, ROC. 116984@cch.org.tw.
authors.forename: Chun-Yu
authors.initials: CY
authors.lastname: Chen
authors.affiliation: School of Chinese Medicine, China Medical University, Taichung, Taiwan, ROC. d5284@mail.cmuh.org.tw.|Department of Hemato-oncology, Children's Hospital, China Medical University Hospital, China Medical University, Taichung, Taiwan, ROC. d5284@mail.cmuh.org.tw.
authors.forename: Kang-Hsi
authors.initials: KH
authors.lastname: Wu
authors.affiliation: School of Medicine, China Medical University, Taichung, Taiwan, R.O.C.. d6582@mail.cmuh.org.tw.|Division of Developmental and Behavioral Pediatrics, Children's Hospital, China Medical University, Taichung, Taiwan, ROC. d6582@mail.cmuh.org.tw.
authors.forename: Huang-Tsung
authors.initials: HT
authors.lastname: Kuo
authors.affiliation: Division of Pediatric General Medicine, Department of Pediatrics, Chang Gung Memorial Hospital at Linko, Kweishan, Taoyuan, Taiwan, R.O.C. arthur1226@gmail.com.|College of Medicine, Chang Gung University, Taoyuan, Taiwan, R.O.C. arthur1226@gmail.com.
authors.forename: Han-Ping
authors.initials: HP
authors.lastname: Wu
mesh_terms: D065634:Cerebrospinal Fluid Leak / Q000150:complications* / Q000175:diagnosis; D002648:Child; D003937:Diagnosis, Differential; D004424:Ear Canal; D005500:Follow-Up Studies; D006801:Humans; D007089:Image Enhancement; D008279:Magnetic Resonance Imaging; D008297:Male; D016920:Meningitis, Bacterial / Q000175:diagnosis / Q000209:etiology* / Q000382:microbiology; D011008:Pneumococcal Infections / Q000175:diagnosis / Q000209:etiology* / Q000382:microbiology; D012008:Recurrence; D013296:Streptococcus pneumoniae / Q000302:isolation & purification*; D014057:Tomography, X-Ray Computed