A 7-year-old boy with pneumococcal meningitis complicated by abscesses involving the cavum septum pellucidum (CSP) and cavum vergae (CV) is reported from the Children’s Hospital and University of California San Diego, CA. He was admitted with fever, headache, vomiting, and nuchal rigidity. Symptoms of rhinorrhea and cough had developed 9 days before admission. CT scan demonstrated sinusitis, left frontal subdural empyema, and abscesses of the CSP and CV. Streptococcus pneumoniae was isolated from the CSF and was susceptible to penicillin and ceftriaxone. Antibiotic and dexamethasone therapy resulted in resolution of fever, headache, and nuchal rigidity. Relapse occurred 3 days after discharge, and CT showed an interval increase in size of CSP and CV. Vancomycin was added to the ceftriaxone and the CSF culture was sterile. A repeat CT 5 days later showed further increase in size of CSP and CV, and hydrocephalus. CT-guided drainage of the CSP released 10 ml of purulent material with negative culture. Following 6 weeks of ceftriaxone and 4 weeks of added vancomycin therapy, CT demonstrated resolution of the CSP abscess and mild enhancement of the CV. The patient recovered with no sequelae. [1]

COMMENT. CSP and CV are a normal finding in infants less than 6 months, but are usually closed by 6 months of age. They can occur as an incidental finding in <20% of children >6 months of age. Hydrocephalus may occur if the cysts enlarge and obstruct the foramen of Munro. Congenital intracranial cysts are discussed in McLone DG, ed Pediatric Neurosurgery 4th ed, Philadelphia:Saunders, 2001:489-498. The present report is considered the first case of postneonatal childhood abscess of the CSP and CV with pneumococcal meningitis. Five previous reports of infection of the CSP and CV are cited by the authors, 4 in adults and one in a 31 -week gestational age neonate with an abscess of the CSP and hydrocephalus associated with Proteus mirabilis meningitis (Li ST, et al. 2002). The abscess resolved after ventriculoperitoneal shunting.