Discussion:
This manuscript was written following CARE guidelines for reporting case reports. This case report presents a unique and complex case of a 2-month-old preterm infant with Bartter syndrome, who developed hydrocephalus and ventriculitis secondary to meningitis. Bartter syndrome, a group of rare renal tubular disorders, typically presents with hypokalemia, metabolic alkalosis, and normal to low blood pressure [1]. Managing Bartter syndrome in preterm infants can be especially challenging due to their physiological immaturity, increased susceptibility to infections, and potential for rapid clinical deterioration [2,6,11]. The neurological complications, including hydrocephalus and ventriculitis, further complicated the management and required a multidisciplinary approach [12,13].
The interdisciplinary approach in managing this patient included consultations from pediatric endocrinologists and neurologists, as well as the primary pediatric team. The team faced the challenge of managing the patient’s electrolyte imbalances while addressing meningitis and its complications, a task made more difficult by the scarcity of literature on such co-occurrences [11,14]. Management included a combination of intravenous antibiotics, electrolyte replacement, and anti-inflammatory medications [7].
This case also underscores the importance of serial radiological investigations, as they played a crucial role in identifying the development of hydrocephalus and ventriculitis [4,5]. MRI findings showed the progression of the patient’s condition, leading to the placement of an external ventricular drain (EVD) for cerebrospinal fluid (CSF) drainage and continued antibiotic therapy [12].
Another challenge encountered in this case was the selection of appropriate antibiotics to treat the patient’s meningitis [3,8,10,15]. A combination of different antibiotics was used, including Vancomycin, Meropenem, Teicoplanin, Ceftriaxone, and Colistin, along with the antifungal medication Voriconazole. The use of intrathecal Teicoplanin reflects the severity of the patient’s condition and the need for aggressive therapy [15].