Frontiers in pediatrics · 2026
Persistent meningeal enhancement on MRI in an infant with culture-negative bacterial meningitis: a case report and systematic review of the literature (2014-2025).
Клинический случайСтатьяНазвание и аннотация: Перевод в очереди
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Su Qunyan, Shao Yiping, Jin Jingjing, Yan Yinghua, Sheng Jiangyin, Tao Anqian, Ruan Guiying, Cui Licheng, Yin Yandan
Аннотация
BACKGROUND: Bacterial meningitis (BM) in infants may be complicated by persistent meningeal enhancement on magnetic resonance imaging (MRI) after clinical cure-a phenomenon frequently misdiagnosed as infection recurrence. However, long-term follow-up data on asymptomatic persistent meningeal enhancement in young infants remain scarce. Here, we report a rare case of 5-month persistent meningeal enhancement following culture-negative bacterial meningitis (CNBM) in a 70-day-old infant, and systematically reviewed 17 eligible studies on meningeal enhancement in infantile bacterial meningitis published between 2014 and 2025 to provide comprehensive evidence for clinical practice.
CASE PRESENTATION: A 70-day-old male infant was admitted on March 22, 2025, with a 2-day history of fever. Laboratory findings were consistent with severe bacterial infection (C-reactive protein [CRP]: 116.16 mg/L, procalcitonin [PCT]: 0.535 ng/mL), and lumbar puncture confirmed central nervous system infection (cerebrospinal fluid [CSF] nucleated cell count: 376.0 × 106/L, 76% neutrophils, protein: 0.86 g/L). Following standardized antimicrobial therapy with meropenem plus vancomycin (total 18-day course) and supportive care, the infant's clinical symptoms, CSF parameters, and systemic inflammatory markers normalized completely. However, contrast-enhanced cranial MRI demonstrated persistent meningeal enhancement for approximately 5 months (from March 27, 2025, to August 26, 2025), without evidence of cerebral parenchymal injury, hydrocephalus, or subdural effusion. Neurodevelopmental assessment using the Gesell Developmental Schedules revealed age-appropriate performance across gross motor, fine motor, language, and social domains, with no neurological sequelae.
CONCLUSION: Asymptomatic persistent meningeal enhancement after clinically diagnosed CNBM in young infants may represent a benign manifestation of delayed post-inflammatory repair when alternative etiologies and active infection have been reasonably excluded. Clinical decision-making should rely on comprehensive integration of clinical symptoms, laboratory parameters, and imaging findings to prevent overtreatment based solely on isolated MRI abnormalities. Given the diagnostic limitations inherent in culture-negative cases, long-term serial follow-up is essential to confirm the benign prognosis of such imaging findings.
CASE PRESENTATION: A 70-day-old male infant was admitted on March 22, 2025, with a 2-day history of fever. Laboratory findings were consistent with severe bacterial infection (C-reactive protein [CRP]: 116.16 mg/L, procalcitonin [PCT]: 0.535 ng/mL), and lumbar puncture confirmed central nervous system infection (cerebrospinal fluid [CSF] nucleated cell count: 376.0 × 106/L, 76% neutrophils, protein: 0.86 g/L). Following standardized antimicrobial therapy with meropenem plus vancomycin (total 18-day course) and supportive care, the infant's clinical symptoms, CSF parameters, and systemic inflammatory markers normalized completely. However, contrast-enhanced cranial MRI demonstrated persistent meningeal enhancement for approximately 5 months (from March 27, 2025, to August 26, 2025), without evidence of cerebral parenchymal injury, hydrocephalus, or subdural effusion. Neurodevelopmental assessment using the Gesell Developmental Schedules revealed age-appropriate performance across gross motor, fine motor, language, and social domains, with no neurological sequelae.
CONCLUSION: Asymptomatic persistent meningeal enhancement after clinically diagnosed CNBM in young infants may represent a benign manifestation of delayed post-inflammatory repair when alternative etiologies and active infection have been reasonably excluded. Clinical decision-making should rely on comprehensive integration of clinical symptoms, laboratory parameters, and imaging findings to prevent overtreatment based solely on isolated MRI abnormalities. Given the diagnostic limitations inherent in culture-negative cases, long-term serial follow-up is essential to confirm the benign prognosis of such imaging findings.