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CASE VIDEO
Year : 2021  |  Volume : 1  |  Issue : 3  |  Page : 205

Cerebrospinal fluid rhinorrhea in a child with recurrent pyogenic meningitis


Department of Pediatrics, JJMMC, Davanagere, Karnataka, India

Date of Submission10-Jul-2021
Date of Decision21-Jul-2021
Date of Acceptance09-Aug-2021
Date of Web Publication31-Aug-2021

Correspondence Address:
Dr. Madhu S Pujar
Door No - 1955, “Madhumann” MCC A Block, Davanagere - 577 004, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ipcares.ipcares_218_21

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How to cite this article:
Pujar MS, Megha P, Raj M N. Cerebrospinal fluid rhinorrhea in a child with recurrent pyogenic meningitis. Indian Pediatr Case Rep 2021;1:205

How to cite this URL:
Pujar MS, Megha P, Raj M N. Cerebrospinal fluid rhinorrhea in a child with recurrent pyogenic meningitis. Indian Pediatr Case Rep [serial online] 2021 [cited 2021 Sep 26];1:205. Available from: http://www.ipcares.org/text.asp?2021/1/3/205/325088

A 9-year-old female child was brought with complaints of fever, headache, and vomiting for the past 2 days and altered sensorium for the past 1 day with history of previous hospitalization for fever, persistent headache and persistent nasal discharge for 3 months [Figure 1]. She was diagnosed to have acute bacterial sinusitis secondary to allergic rhinitis. The child had no h/o trauma or previous surgeries. On examination, she had low Glasgow Coma Scale (GCS) (12/15) and had signs of meningeal irritation. Laboratory parameters showed neutrophilic leukocytosis and raised a C reactive protein (CRP) of 226.7 mg/dL suggestive of bacterial infection. Cerebrospinal fluid (CSF) analysis showed a turbid fluid with laboratory features, suggestive of pyogenic meningitis. During the hospital stay, the child was observed to have a continuous watery nasal discharge from right nostril suggesting CSF rhinorrhea (Video 1)[Additional file 1]. Contrast-enhanced magnetic resonance imaging brain showed nasal meningoencephalocoele in the anterior cranial fossa.
Figure 1: Clear, watery discharge (CSF) draining from the right side of the nose on sitting upright tilting the head forward

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CSF leaks are extracranial egress of CSF into the adjacent paranasal sinuses or tympanomastoid cavity due to an osteodural defect involving skull base. It may be due to many causes such as iatrogenic (endoscopic sinus surgeries, neurosurgical procedures), accidental trauma, and congenital malformations such as basal cephaloceles.[1] Most of the times, it is misdiagnosed as allergic rhinitis.[2] Patients with CSF rhinorrhea are at risk of developing recurrent meningitis due to spread of infection from the sinonasal cavity. There are many tests to confirm CSF rhinorrhea and to differentiate from nasal discharge such as handkerchief test showing halo sign, reservoir sign, and biochemical analysis of the nasal fluid. Neuroimaging confirms the site of leak.[3]

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the legal guardian has given her consent for images and other clinical information to be reported in the journal. The guardian understands that names and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Hiremath SB, Gautam AA, Sasindran V, et al. Cerebrospinal fluid rhinorrhea and otorrhea: A multimodality imaging approach. Diagn Interv Imaging 2019;100:3-15.  Back to cited text no. 1
    
2.
Ulrich MT, Loo LK, Ing MB. Recurrent CSF rhinorrhea misdiagnosed as chronic allergic rhinitis with subsequent development of bacterial meningitis. Case Rep Med 2017;2017:9012579.  Back to cited text no. 2
    
3.
Oakley GM, Alt JA, Schlosser RJ, et al. Diagnosis of cerebrospinal fluid rhinorrhea: An evidence-based review with recommendations. Int Forum Allergy Rhinol 2016;6:8-16.  Back to cited text no. 3
    


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