An 8-month-old girl was treated for Haemophilus influenzae type b meningitis with IV ceftriaxone. She improved initially, but on the sixth day of therapy fever recurs, the anterior fontanelle becomes bulging, and she vomits repeatedly. Transillumination of the skull is positive. What is the most likely complication?

• A Relapse of untreated meningitis
• B Hydrocephalus requiring shunt
• C Subdural effusion ✓
• D Drug fever from ceftriaxone

Explanation

Recurrence of fever with bulging fontanelle, vomiting and positive transillumination during treatment of H. influenzae meningitis points to a subdural effusion, the classic complication of this organism in infants. Effusions are often sterile and many resolve spontaneously, so aspiration is reserved for large collections or suspected empyema. Drug fever does not cause a bulging fontanelle or transillumination changes.

Reference: Nelson Textbook of Pediatrics, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.