Bacterial meningitis with normal cerebrospinal fluid findings. Report of a case and review of the literature.

Bacterial meningitis presenting with normal initial CSF findings is rare and could be confusing to the physicians. Such an entity was observed in this first case report from Lebanon on an 8-month-old female febrile infant whose initial CSF studies were normal despite the culture yielding Streptococcus pneumoniae. Thus, this case emphasizes the need that physicians should start antimicrobial therapy, pending culture results, whenever bacterial meningitis is clinically suspected, even if initial CSF investigation of cellular, protein, sugar and gram-strain results do not reveal abnormal findings. In addition, repeat lumbar puncture should be considered in all febrile patients having clinical features suggestive of this diagnosis.