A 10-month-old infant is treated for Haemophilus influenzae type b meningitis for 5 days. He defervesces by day 3 but on day 7 develops recurrent fever, bulging fontanelle, and increasing head circumference. Repeat CSF from LP shows glucose 50 mg/dL, protein 60 mg/dL, and 20 WBC/mm3 with sterile culture. What is the most likely diagnosis?
- A Relapse of bacterial meningitis
- B Subdural effusion ✓
- C Brain abscess
- D Drug fever
Correct answer: B. Subdural effusion
Explanation
Subdural effusion is the most common complication of bacterial meningitis in infants under 18 months, especially with H. influenzae. It presents as recurrent fever, bulging fontanelle, and increasing head circumference after initial clinical improvement, with a normalizing CSF profile. Diagnosis is confirmed by transillumination or ultrasound. Most are benign and resolve spontaneously; large symptomatic collections may need aspiration.
Reference: Nelson Textbook of Pediatrics, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.