Female sex, 11 months old, with no significant morbid history.
The patient developed fever, diarrhea and vomiting for five days.
There were no significant changes in the initial physical examination.
Urine sediment and blood count were normal; PCR 1.6 mg/dl and latex for rotavirus was positive.
She was hospitalized for oral intolerance.
On the third day of hospitalization vomiting and fever persisted and somnolence was added.
A pulsatile sinus was detected and a lumbar puncture was performed.
The CSF cytochemical study had 2,500 cells (polymorphonuclear 70%); glucose 38 mg/dl; and proteins 82 mg/dl, no microorganisms were observed in Gram stain.
Bacterial meningitis was diagnosed and antimicrobial treatment with ceftriaxone (100 mg/kg/day) was initiated.
The patient remained febrile, with no significant clinical improvement.
On the sixth day of hospitalization, a new lumbar puncture was performed with 450 cells (80% mononuclear), glucose 54 mg/dl, protein 110 mg/dl. No bacteria were observed in Gram again.
A qualitative Epstein (VEB) virus was identified in CSF by polymerase chain reaction (PCR).
A multi-slice computed tomography scan showed bilateral frontal-parietotemporal hygroma.
On the ninth day of hospitalization, an increase in CSF culture was observed. Ampicillin (400 mg/kg/day) was added to the treatment.
The patient continued with fever, so on the sixteenth day of hospitalization amikacin (15 mg/kg/day) was added.
Immunological study was performed with measurement of serum immunoglobulin concentrations within normal ranges.
Treatment with antibiotics was prescribed in all patients.
Serology for human immunodeficiency virus (HIV) was negative.
The subsequent evolution was favorable, the fever ceased, good oral tolerance and the state of consciousness improved.
She was discharged after 32 days of hospitalization.
Identification of CL was carried out in an epidemiological study in which it was found that the lowest consumed non pasteurized cheese frequently.
Parents were asked to sample cheeses from the centers where they purchased the product, identifying the microorganism in one of the samples usually diagnosed by an external private laboratory.
The results were later confirmed by our National Register of References Laboratory (National Institute of Health of Peru).
