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An unusual cause of torticollis in childhood

Background: Recurrent meningitis in childhood is a rare entity with fatal consequences. Known etiologies of recurrent meningitis include cranial anatomical defects, immunodeficiency, and hyposplenism. We describe a case of 6 years boy presenting as torticollis due to recurrent meningitis following a head injury 3 years back. Case report: A 6 years boy presented with high grade fever with neck deviation and multiple episodes of projectile vomiting and multiple episodes of GTCS for 4 days prior to admission. There is history of similar episode of illness 5 months back when the child was treated as meningitis in a local hospital and given injectable antibiotics. CECT brain study was normal. There is past history of head injury due to fall from height 3 years back followed by symptoms suggestive of CSF rhinorrhea. On examination, the child was found to be irritable but haemodynamically stable. Neurological examination revealed a neck rigidity and fixation to left side. Rest examination was normal. Blood investigations revealed neutrophilic leucocytosis, elevated CRP and procalcitonin levels. CEMRI brain revealed cystic encephalomalacia in left basifrontal lobe herniating through cribriform plate into naso-ethmoid region. CSF examination findings were suggestive of pyogenic bacterial meningitis but cultures were sterile. Management: The child was treated as acute pyogenic meningitis and trans nasal endoscopic closure of defect is planned after treatment of the infection. Conclusion: Recurrent meningitis in children is a rare condition, and if present should always be evaluated for the presence of predisposing factors so as to prevent severe neurological handicap in future.
Keywords: Childhood; meningitis; recurrent; rhinorrhea; torticollis