ASSOCIATION OF MENINGITIS AND PERICARDITIS IN INVASIVE PNEUMOCOCCAL DISEASE: A RARE CASE

ABSTRACT Objective: To report a rare case of a child with invasive pneumococcal disease that presented meningitis associated with pericarditis. Case description: This report describes the unfavorable clinical course of a previously healthy 6-months-old female infant who initially presented symptoms of fever and respiratory problems. A chest X-ray revealed an increased cardiac area with no radiographic changes in the lungs. After identifying a pericardial effusion, the patient experienced seizures and went into coma. Pneumonia was excluded as a possibility during the clinical investigation. However, Streptococcus pneumoniae was identified in the cerebrospinal fluid and blood cultures. An initial neurological examination showed that the patient was brain dead, which was then later confirmed according to protocol. Comments: Purulent pericarditis has become a rare complication of invasive pneumococcal disease since the advent of antibiotic therapy. Patients with extensive pneumonia are primarily predisposed and, even with early and adequate treatment, are prone to high mortality rates. The association of pneumococcal meningitis and pericarditis is uncommon, and therefore difficult to diagnose. As such, diagnostic suspicion must be high in order to institute early treatment and increase survival.

摘要
研究目的：报告1例以脑膜炎合并心包炎为临床表现的罕见侵袭性肺炎链球菌（Streptococcus pneumoniae）感染患儿病例。
病例描述：本报告记述1名既往健康的6月龄女婴的不良临床病程。该患儿初始表现为发热与呼吸道症状。胸部X线检查显示心影增大，肺部未见影像学异常。检出心包积液后，患儿出现癫痫发作并陷入昏迷。临床排查期间已排除肺炎可能，但脑脊液（cerebrospinal fluid）与血培养均检出肺炎链球菌。首次神经系统检查即提示患儿脑死亡，后续经标准化诊疗流程确认该诊断。
讨论：自抗生素疗法问世以来，化脓性心包炎已成为侵袭性肺炎链球菌疾病的罕见并发症。既往认为广泛性肺炎为主要易感因素，即便接受早期规范治疗，患者仍面临较高的死亡率。肺炎链球菌性脑膜炎合并心包炎的情况较为罕见，因此诊断难度较大。为此，需提高临床诊断警惕性，以便尽早启动治疗以提升患者存活率。