A Storm in the Cradle: Fulminant Neisseria meningitidis Infection with Multifocal CNS Complications in a 3-Month-Old Infant

Abstract

Bacterial meningitis in early infancy is a life-threatening condition associated with high morbidity and mortality. Neisseria meningitidis infection is uncommon in infants younger than three months but may present with a rapidly progressive and fulminant clinical course. A case of a 3-month-old male infant presenting with fever and refractory generalized seizures requiring mechanical ventilation is presented here. Cerebrospinal fluid (CSF) analysis revealed elevated protein with minimal pleocytosis, while culture confirmed Neisseria meningitidis. Neuroimaging demonstrated diffuse cerebral edema with extensive central nervous system (CNS) involvement, including subdural empyema, subdural effusion, encephalitis, cerebral abscess formation, and subarachnoid hemorrhage. 
Despite aggressive antimicrobial therapy and multiple antiepileptic drugs, the patient developed focal seizures. Neurosurgical intervention was advised but declined by caregivers. This case highlights the aggressive nature of meningococcal infection in early infancy, atypical CSF findings, and the importance of early neuroimaging and multidisciplinary management. Prompt diagnosis and timely intervention are critical to improving outcomes.