Strange case leaves me with questions.
15 yo male arrived with severe ha and and pain. pt had been "stabbed" x12 with unknown instrument (the first doctor told him it looked like a box cutter did it) on back of neck,back and post chest 8 days prior. wounds were all similar and about 3 cm and stapled shut by other hospital. apparently cxr was neg. pt did fairly well till 3days pat when above sx began. one vomit episode. min photophobia complained by pt but not seen on exam. rigidity of neck difficult to evaluate due to the stapled wounds. no fever x 2 here. neuro intact and pt alert if a bit whiny. abdomen mod tender diffusely except for rlq. no guarding rigidity
i got a ct of head and abd. no bleed or injury noted in head and abd neg x a small rt ptx.
pt with normal bp and pulse and temp
wbc was 20k. chem 7 and ua tox neg.
Lp was cloudy and had 2700 abc and 3000 rbc and neg gram stain. normal csf glucose and high protein culture neg x 2 days now.
I began antibiotics upon seeing the spinal fluid drip out.(pressure not measured but it was certainly not high)
pt admitted to the pedi hospitalist
my question is could the meningitis be due to a "stab" of the neck? also, if the culture grows nothing after 2 days do you stop antibiotics? the blood cx was neg. the antibiotics were given right after the LP performed. Hsv pcr is pending. I did not do a west nile.
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