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].