Currarino syndrome as an etiology of a neonatal Escherichia coli meningitis

Abstract

We report the case of a 29-day-old baby girl in whom Escherichia coli meningitis led to the diagnosis of Currarino syndrome (CS) (OMIM 176450), an autosomal-dominant genetic disorder associated with sacral agenesis, anorectal malformation, presacral masses and spinal cord malformations. Her condition improved with antibiotics and early surgical treatment. A familial study identified other genetically related individuals with similar symptoms. Journal of Perinatology (2007) 27, 589-591; doi:10.1038/sj.jp.7211783Keywords: neonate; anorectal malformation; bacterial meningitis; Currarino syndrome; HLXB9 gene Case report A 29-day-old baby girl was referred to our hospital due to a fever of 381C, anorexia and unusual behavior. Clinical examination identified symptoms of neurological problems and shock, including moaning and cutaneous hyperesthesia. A lumbar puncture revealed high protein (8.38 g/l) and low glucose (0 g/l) levels. The cerebrospinal fluid (CSF) was cloudy with 6740 cells/mm 3 containing 91% neutrophils. Culture of the fluid isolated Escherichia coli K1, and the infant was then given ceftriaxone (100 mg/kg/day) for 21 days. Recovery was observed after 2 days of treatment. Improvement was confirmed by biochemical examination of the CSF. After 10 days of treatment, culture of the CSF isolated Bacteroides, which led to the addition of metronidazole (20 mg/kg/day) to the treatment regimen.A cutaneous mark in front of the right sacroiliac joint region was observed on the infant during hospitalization, prompting a sacrum X-ray. The X-ray identified hemi-agenesis of the right sacral pieces with conservation of S1, indicating a sickle-shaped sacrum. Anorectal examination identified a rectal stenosis.Magnetic resonance imaging (MRI) revealed a presacral mass with a probable neurenteric fistula, a tethered cord with low-lying medullary conus below the L3-L4 level and an intraspinal lipoma (Figure 1). The cerebral MRI was normal. Currarino syndrome (CS) was diagnosed (OMIM 176450) based on these observations. A single-stage surgical treatment was performed with a posterior median sagittal approach 21 days after the beginning of antibiotherapy. The tethered cord was released, the presacral tumor and the intra-spinal lipoma were excised, the dural sheath was closed and the region between the rectum and the presacral mass was repaired. Histological examination of the excised mass confirmed a mature teratoma.At 1 year of age, the girl had normal psychomotor development. The follow-up was favorable, except for the persistence of chronic constipation.A familial study was then conducted as some intrafamilial correlation has been noted in half of CS cases, where autosomaldominant inheritance and a broad inter-and intrafamilial phenotypic variability are observed. This study identified at least five members of the family with sacral anomalies, which had not been previously classified (Figure 2). Patient III2 had Streptococcus agalactae and Bacteroides meningitis revealing a neurenteric cyst and a presacral anterior meningo...

Currarino syndrome and spinal dysraphism

“…Bacterial meningitis in the context of fistula formation between the ventral thecal sac and bladder or colon has also been reported. 11,12 Older patients with a mild phenotype may present with chronic constipation or scoliosis due to sacral dysgenesis in late childhood or as adults. 16,17,19,21 Features of this syndrome were noted as early as 1837, 4 but it was not until the 1981 report by Currarino et al 7 that the clinical triad was defined as a syndrome that could occur from a single embryological process.…”

Currarino syndrome with intramedullary spinal cord abscess related communication between the tethered cord and a presacral mass: A case report

“…The most frequent symptom was constipation (65 patients: 54.2%), followed by urogenital symptoms (13 patients: 10.8%), including urinary tract infection and neurogenic bladder. Furthermore, meningitis is one of the most severe complications in CS and occurred in 7e11% of all cases, including familial cases in previous reports [9]. The communication between the spinal canal and the presacral tumor through the tethered cord is considered to be the cause of the patient's meningitis and spinal cord abscess [1,14,15].…”

Mutation analysis of the motor neuron and pancreas homeobox 1 (MNX1, former HLXB9) gene in Swedish patients with Currarino syndrome

“…It is particularly important to identify patients with presacral teratomas, which may be potentially malignant, or patients with meningoceles who may benefit from treatment to avoid future complications [27][28]. Meningitis is one rare but serious complication reported in patients with CS [29].…”