Nessle Charles Nathan, Black Allison K, Farge Justin, Statler Victoria A
Department of Pediatrics, University of Louisville, Louisville, KY 40292, USA.
Department of Pediatric Cardiology, University of Pittsburgh, Pittsburgh, PA 15260, USA.
Children (Basel). 2017 Oct 16;4(10):87. doi: 10.3390/children4100087.
A 5-month-old previously healthy female presented with a one-week history of fever and increased fussiness. Her presentation revealed an ill-appearing infant with an exam and cerebrospinal fluid (CSF) studies concerning bacterial meningitis; CSF cultures grew . Additionally, brain magnetic resonance imaging (MRI) demonstrated cervical osteomyelitis. Despite multiple days of antibiotic therapy, she remained febrile with continued pain; MRI showed oligoarticular effusions, and aspiration of these joints yielded bloody aspirates. Evaluations for coagulopathy and immune complex-mediated arthropathy were negative. The patient improved following appropriate antibiotic therapy and spontaneous resolution of hemarthroses, and was discharged to a short-term rehabilitation hospital. is a small, encapsulated coccobacillus that is part of the commensal oral flora of animals. It most commonly causes skin infections in humans, yet is a rare cause of meningitis in the pediatric population, especially in children <1 year of age. Transmission due to is most commonly due to direct contact with animals. To our knowledge, this is the first case of oligoarticular hemarthroses and cervical osteomyelitis complicating meningitis. This case highlights the physician's potential for cognitive bias and premature anchoring, and the resulting implications in delivering excellent patient care.
一名5个月大、既往健康的女性患儿，出现发热及易激惹加重1周的症状。其临床表现为一名看起来不适的婴儿，检查及脑脊液（CSF）检查提示细菌性脑膜炎；CSF培养生长出……此外，脑部磁共振成像（MRI）显示颈椎骨髓炎。尽管进行了多日抗生素治疗，她仍持续发热且疼痛；MRI显示少关节积液，对这些关节进行穿刺抽吸得到血性抽出液。对凝血功能障碍和免疫复合物介导的关节病的评估均为阴性。经适当抗生素治疗及关节积血自行消退后，患儿病情好转，并被转至短期康复医院。……是一种小型、有荚膜的球杆菌，是动物口腔共生菌群的一部分。它最常引起人类皮肤感染，但在儿科人群中是脑膜炎的罕见病因，尤其是在1岁以下儿童中。……传播最常见的原因是与动物直接接触。据我们所知，这是首例少关节积血和颈椎骨髓炎并发……脑膜炎的病例。该病例凸显了医生存在认知偏差和过早锚定的可能性，以及由此对提供优质患者护理产生的影响。
