Management of rare intraventricular empyema secondary to late onset neonatal meningitis in an infant: A case report

ABSTRACT Introduction and importance: Intraventricular empyema (IVE) is life-threatening intracranial infection characterized by the accumulation of purulent material within the brain's ventricular system. It is a rare complication of bacterial meningitis in neonates. Escherichia coli , a common cause of late-onset neonatal meningitis, can occasionally lead to severe complications such as ventriculitis and IVE. Early diagnosis and intervention are critical to preventing long-term neurological sequelae or death. Case presentation: A 44-day-old male Ethiopian infant presented with fever, irritability, vomiting, poor feeding, and abnormal body movements. Physical examination revealed bulging fontanelle and lethargy, suggesting raised intracranial pressure. Cerebrospinal fluid analysis confirmed bacterial meningitis, and brain imaging revealed bilateral intraventricular abscesses. The patient was diagnosed with intraventricular empyema secondary to late-onset meningitis caused by Escherichia coli . Management included intravenous administration of meropenem, external ventricular drainage to relieve pressure and remove purulent material, Neuroendoscopic lavage for direct intraventricular cleaning, and later placement of a ventriculoperitoneal shunt to manage hydrocephalus. The patient responded well to treatment, showing marked clinical improvement. The infant recovered well and demonstrated appropriate developmental progress at three-month follow-up. Clinical discussion: This case underscores the critical role of prompt diagnosis and a comprehensive therapeutic strategy in managing neonatal intraventricular empyema. Integration of neuroimaging, appropriate antimicrobial therapy, and endoscopic surgical interventions significantly contributed to the favorable outcome. Multidisciplinary care remains essential for addressing complications such as hydrocephalus and ensuring long-term recovery. Conclusion: Early recognition and integrated medical-surgical intervention can significantly improve outcomes in an infant with intraventricular empyema. Advanced neuroimaging, targeted antibiotics, and Neuroendoscopic techniques are pivotal in managing this life-threatening condition. Highlights