Gemella haemolysans is a rare pathogen in cases of bacterial meningitis. We present a case of meningitis due to G. haemolysans in a 17-month-old boy. This is the first reported case of Gemella meningitis in a child. The patient completely recovered following intravenous therapy with linezolid and chloramphenicol.A 17-month-old boy who was diagnosed at the age of 2 months with complex congenital heart disease (a perimembranous ventricular septal defect and a small patent ductus arteriosus) was admitted to the hospital with complaints of fever, vomiting, and loss of appetite for 2 days. A physical examination revealed an ill-appearing baby with a head circumference of 46.5 cm, a weight of 10,500 g, and a height of 77 cm. His body temperature was 39.2°C, his heart rate was 164/min, and his respiratory rate was 28/min. The anterior fontanelle was closed, and he had a grade 2/6 systolic murmur at the left sternal border. There was no hepatomegaly or splenomegaly, and he had no sick contacts or trauma. He had received three doses of hepatitis B vaccine, as well as polio, diphtheria, tetanus toxoid, pertussis, and first Bacille Calmette-Guerin (recommended in the childhood immunization schedule in Turkey) vaccines, and had not received Haemophilus influenzae type b vaccine (recommended in the childhood immunization schedule in Turkey for 3 months). His medications included digoxin and spironalactone because of heart disease. There was no family history of invasive bacterial infection. Blood, cerebrospinal fluid (CSF), and urine samples were taken and sent to the laboratory for culture and biochemical analyses. The complete blood count showed a white blood cell count of 21,830/mm 3 , of which 74% were neutrophils, 8% were bands, 16% were lymphocytes, and 2% were monocytes; a hemoglobin level of 11.9 g/dl; and a platelet count of 170,000/mm 3 . His serum basic chemistry was normal, except for a glucose level of 183 mg/dl. The level of C-reactive protein was 30.4 mg/dl, and the erythrocyte sedimentation rate was 56 mm/h. Serum immunoglobulin and subclass levels were normal, and the serum was negative for anti-HIV antibody. Urine analysis and a chest radiograph were normal. Transthoracic echocardiography was negative for endocarditis. CSF analyses showed a protein concentration of 102 mg/dl, a glucose concentration of 11 mg/dl, a red blood cell count of 250/mm 3 , and a white blood cell count of 4,500/mm 3 , of which 88% were neutrophils and 12% were lymphocytes. The CSF was negative by gram staining. The diagnosis was suspicion of bacterial meningitis, and empirical antibiotic treatment was started with ampicillin (300 mg/kg/ day) and cefotaxime (200 mg/kg/day) as part of our clinical protocol. Dexamethasone (0.6 mg/kg/day, 4 days) was given intravenously before the first administrated antibiotic dose. The CSF specimen was cultured on 5% sheep blood, eosinmethylene blue, and chocolate agars at 35°C in 5 to 10% CO 2 for 48 to 72 h. Because of a suspicion of endocarditis, three pairs of aerobic and anaerobic blood cultures,...

Arthrogryposis-renal dysfunction-cholestasis syndrome is a rare lethal disorder that involves multipl organ system. It is inherited autosomal recessive and caused by defects in the VPS33B and VIPAR genes. Three cardinal findings of this syndrome are arthrogryposis, renal tubular dysfunction and cholestasis.The other organ involvements including ichthyosis, central nervous system malformation, platelet anomalies, congenital heart defects and severe failure to thrive are sometimes associated with this syndrome. Clinical findings, organ biopsy and mutational analysis can help for diagnosing but there is no curative treatment except supportive care. Several symptoms of this condition are already usually present in the neonatal period: arthrogryposis, neonatal cholestasis, skin lesions, among others. Usually survival is until the first year of life. We present a newborn whose evolution was rapidly fatal.

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