The older patient, 1 year 4 months old, male, previously healthy.
He had been to kindergarten for four months.
The PNI was immunized every day, including a tetanus toxoid conjugate vaccine (ACWY-TT), at 12 months of age.
On the fourth day, the patient presented with fever up to 40.2 °C, decay, irritation and food refusal. The parents consulted a symptomatic anti-steroidal anti-inflammatory drug (AD).
On the following day, the patient presented with greater compromise of the general condition and appearance of punctate lesions in the thorax and back, which expanded to the extremities.
The patient was taken to the emergency department with fever 39.3 °C, tachycardia 166 bpm, and polypnea 43 bpm.
He was admitted in poor general condition, pale, feverish, with a slow, porous capillary refill, with petechiae on trunk and extremities, without meningeal signs, interpreting as a septic shock.
Management was initiated with orotracheal intubation and volume intake, two blood cultures were obtained and empirical antimicrobial therapy was initiated with ceftriaxone 100 mg/kg/day and vancomycin 60 mg/kg/day, associated with dexamethasone 0.6 mg/day.
Laboratory tests showed leukocytosis of 16.900/mm3 and CRP of 168 mg/L (normal value < 10 mg/L), associated with a coagulation disorder.
He presented severe edema and hemodynamic instability requiring vasoactive amines.
After stabilization, a lumbar puncture was performed 7 h post-initiation of antibacterial agents, which resulted in purulent CSF with increased pressure, with 8600 leukocytes, 3 mg/dL Gram stain and 3 mg/dL Gram stain.
The patient remained stable at 48hours of gestation with hemodynamic changes and decreased inflammatory parameters.
Blood and CSF cultures were negative.
The molecular study of CSF (PRC) performed at the Institute of Public Health (ISP) confirmed N. meningitidis serogroup B. The patient completed 10 days of therapy with ceftriaxone in good conditions.
