Bacterial meningitis in a known case of steroid-resistant nephrotic syndrome

Abstract

Nephrotic syndrome (NS) is a kidney disorder in which, excess protein is being excreted through urine. While most cases of idiopathic nephrotic syndrome respond to steroid therapy and experience a limited number of relapses prior to complete remission, some cases suffer from frequent relapses and become steroid-dependent or are primarily steroid-resistant. Treatment options are limited to immunosuppressive drugs with significant side effect profiles. Infections in nephrotic syndrome are common and can be severe. Meningitis is one of the complications associated with nephrotic syndrome. Here, we report a child with steroid-resistant nephrotic syndrome (SRNS) with meningitis. Early detection and appropriate treatment of these complications can be lifesaving.

Streptococcus pneumoniae meningitis in a child with idiopathic nephrotic syndrome: a case report

“…Previous reported cases of bacterial meningitis in children with NS have occurred in resource-poor countries with incomplete vaccination or with organisms not covered by routine childhood vaccines [3][4][5][6]. In contrast, our patient developed an invasive S. pneumoniae infection even in a country as resource rich as the USA, with universal access to childhood immunizations.…”

“…Typically, bacterial meningitis presents with the sudden onset of fever, headache, and neck stiffness that is usually accompanied by nausea, vomiting, photophobia, and altered mental status. Other reported cases of bacterial meningitis in NS presented with fever, nausea or vomiting, headaches, seizures, or altered mental status, as presenting symptoms [ 3 , 4 , 6 ]. These patients, even without the diagnosis of NS, would have warranted an evaluation for potential meningitis.…”

“…Children with NS are at increased risk of bacterial peritonitis, pneumonia, and cellulitis, as well as sinusitis/tonsillitis, gastroenteritis, and urinary tract infections [1,2]. Bacterial meningitis, a serious complication of NS, has not been highlighted as a potential infection in NS in recently published reviews, despite the growing number of case reports of this serious complication [3][4][5][6].…”