We describe 5 pediatric cases of Neisseria meningitidis serogroup W135 infection. Infectious and/or reactive extrameningeal involvement was frequent. One patient had a persistent postmeningococcal inflammatory syndrome. Four of 5 isolates belonged to the clonal complex 37. The important risk of extrameningeal complications must be borne in mind when treating children with N. meningitidis W135 infection.
Résumé -
Mots clés : Syndrome de Münchausen par procuration, CL-SM/SM, analyse des cheveux
Abstract -Introduction:We report the case of an infant (4 months) hospitalized in a neurological intensive care unit for seizures from unknown aetiology. Patient and method: During the stay in hospital, were observed repeatedly, on six times, a very sudden drowsiness, abnormal motions and a hypotonia.The feeding tube brought back a thick purple liquid. A toxicological screening (GC-MS and HPLC-DAD) was performed on a sample of this liquid. Other samples were collected from blood, urine, gastric liquid, administered drugs, milk from the feeding bottle and hair. Hairs were tested by LC-MS/MS in search of psychotropic drugs. Results: In the purple liquid were found: bromazepam, phenobarbital, diazepam and its metabolite nordazepam. Only phenobarbital and diazepam had been prescribed. The test on the hairs taken 15 days later, showed 5 psychotropic drugs: diazepam (18 pg/mg), bromazepam (142 pg/mg), clobazam (11 pg/mg), zolpidem (276 pg/mg) and cyamemazine (110 pg/mg). Discussion: The phases of drowsiness seemed to tally with the parents visits. The mother was found to have an odd-looking behaviour. A purple liquid was found in the infant stomach. All these 3 facts drew the attention of the clinical staff to a possible Munchausen syndrome by proxy, a particular form of ill-treatment of children. The results of the toxicological tests seemed to back up their suspicion. Conclusion: The hair tests showed 4 psychotropic drugs which were not prescribed by the paediatricians. The fact was reported to a judge. By a judicial decision, the parents were deprived of the custody of the infant. The medical
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