Postoperative meningitis due to Pandoraea pnomenusa in a child with recurrent medulloblastoma: first CSF-proven case.

Pandoraea pnomenusa is an emerging non-fermenting Gram-negative bacillus most often described in cystic fibrosis and structural airway disease. CNS infection has not been documented previously. A 13-year-old boy with prior midline suboccipital craniectomy and chemoradiotherapy for classic medulloblastoma presented with obstructive hydrocephalus from recurrence. After emergency external ventricular drainage and gross total excision, he developed fever and meningeal signs on postoperative day 3. CSF culture yielded Pandoraea pnomenusa, confirmed by MALDI-TOF MS (99.9%). The isolate was resistant to meropenem and ciprofloxacin but susceptible to piperacillin-tazobactam, chloramphenicol and cotrimoxazole (MIC 0.12 μg/mL). Cotrimoxazole therapy led to resolution.