Adrenal Insufficiency in 6-Year-Old Boy with Pneumococcal Meningitis

ABSTRACT

A 6-year-old boy with acute onset fever, mental change, and vomiting was admitted to the intensive care unit. He had neck stiffness and positive Kernig/Brudzinski sign. He showed neither skin pigmentation nor hirsutism. Brain magnetic resonance image showed diffuse sulcal T2 fluid attenuated inversion recovery hyperintensity in bilateral cerebral hemisphere. We started intravenous vancomycin and ceftriaxone. There was streptococcus pneumoniae in cerebrospinal fluid (CSF) culture. He showed no improvement of mental change and hemodynamic instability. His adrenocorticotropic hormone and cortisol level was 5.47 pg/mL and 15.08 µg/dL. We suspected adrenal insufficiency and prescribed intravenous hydrocortisone (50 mg/m2/day). Mental change and hemodynamic instability were improved after that. The CSF culture was negative 24 days after admission and he was discharged with oral hydrocortisone (10 mg/m2/day). In synacthen test (250 µg), basal and 60 minutes 17-OH-progesterone level was 3.84 ng/mL and 5.04 ng/ mL. We suspected non classic congenital adrenal hyperpalsia and planed further work up.