[Meningitis and interferon-alpha in the cereprospinal fluid. What diagnostic and therapeutic approach? A case report]. / Méningite et présence d'interféron alpha dans le liquide céphalorachidien. Quelle attitude diagnostique et thérapeutique? A propos d'un cas.

BACKGROUND: In meningitis without germs, the existence of an inflammatory syndrome leads toward a bacterial etiology while the detection of interferon-alpha (IFN-alpha) in the cerebrospinal fluid (CSF) argues for a viral meningitis. The coexistence of the inflammatory syndrome and the presence of IFN-alpha in the CSF makes this differentiation difficult. The reported case yields the picture and begs the question on the diagnostic approach and the required therapeutic attitude. CASE REPORT: A six-week-old infant, exclusively breast-fed, was hospitalized for fever. The examination showed an important inflammatory syndrome and meningeal attempt with a cellularity at 94/mm3 with 53% polymorphonuclear neutrophils, contrasting with normal proteinorrhachia and glycorrhachia. The IFN-alpha in the CSF was present at 4 UI/mL while the bacteriological culture and the viral search by PCR were negative. The clinical and biological worsening within the first 36 hours, in spite of the parenteral dispensation of a triple antibiotic therapy (amoxicillin, ceftriaxone, netilmicin), then a favorable clinical and biological response after adjunction of vancomycin, led toward a pneumococcal meningitis with reduced sensitivity to beta-lactams. The maternal antibiotic therapy by amoxicillin and its presence in the maternal milk favored the hypothesis of a decapitated bacterial meningitis. CONCLUSION: In the presence of a meningitis without germs, the coexistence of a sizable inflammatory syndrome and the detection of IFN-alpha in the CSF must be considered as an unusual phenomenon and motivate the pursuit of antibiotic therapy until viral identification.

[Acute osteomyelitis in a child with homozygous sickle cell anemia. Difficulty in early diagnosis]. / Ostéomyélite aiguë chez l'enfant drépanocytaire homozygote. Difficulté du diagnostic précoce.

Febrile painful edema of a limb segment in Black children should suggest a bone complication (infarct or osteomyelitis) of a homozygous sickle cell anemia. The possibility of an early diagnosis can be improved by scintigraphy since the appearance of radiologic signs is delayed in relation to functional symptomatology onset. The risk of an infectious graft, particularly from Salmonella in children under 2 years, on a bone infarct makes it essential to combine routine antibiotic therapy with the orthopedic treatment, to provide resolution of the very often quite impressive lesions.