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505 - A Unique Case of Infectious Pachymeningitis in a Pediatric Patient

Friday, February 28, 2025

5:00 PM - 6:30 PM MST

Presenting Author(s)

AR

Aaron Rubenstein, n/a

Medical Student
Kings County Hospital
Brooklyn, New York, United States

Co-Author(s)

RT

Rebecca Takele, DO

PM&R Resident Physician
SUNY Downstate Health Science University
Brooklyn, New York, United States
AT

Andrew Tom, MD

Physician
Kings County Hospital
Brooklyn, New York, United States
RD

Robert DePorto, DO

Attending Physician
Kings County Hospital
Brooklyn, New York, United States
Sanjeev Agarwal, MD

Program Director
SUNY Downstate Health Science University
Brooklyn, New York, United States

Case Diagnosis: Infectious Pachymeningitis

Case Description: A 10-year-old male with a history of obesity, sickle cell trait, and speech delay presented to the emergency department with a 3-day history of headache, photophobia, nausea, fever, cough, and congestion. A head computed tomography (CT) scan showed severe pansinusitis, and orbital magnetic resonance imaging (MRI) revealed asymmetric pachymeningeal thickening concerning for pachymeningitis.

The following day, the patient experienced a generalized tonic-clonic seizure lasting less than 1 minute, followed by a postictal state lasting a few minutes. Todd’s paresis was observed on the right hemibody. Over the next two days, the patient experienced worsening seizures that were refractory to antiseizure medications, necessitating intubation and mechanical ventilation. Upon extubation, the patient exhibited new, persistent deficits in endurance, strength, and balance. An unsteady gait, inability to self-correct, and hip flexion weakness were noted, along with limitations in activities of daily living.

Discussions: Pachymeningitis is a rare but serious inflammatory disease of the dura mater, caused by a variety of infections ranging from tuberculosis to cases of acute sinusitis and otitis media. This patient's complicated hospital course, involving infectious pachymeningitis secondary to sinusitis and frequent, refractory seizures, resulted in severe, new functional deficits that persisted weeks after discharge and impaired daily life.

Conclusions: New-onset neurological symptoms in cases of acute sinusitis should raise concern for pachymeningitis. Early diagnosis and intervention are critical to prevent long-term neurological damage. Complications of pachymeningitis can result in new deficits in functional capacity and daily activities, which may persist depending on the etiology of the condition. Similar to idiopathic hypertrophic spinal pachymeningitis, early initiation of occupational and physical therapy plays a crucial role in reducing these deficits and minimizing their impact on patients' quality of life.