Campylobacter infection masquerading as meningitis-like illness: two cases presenting with nuchal rigidity and elevated intracranial pressure

Introduction

Campylobacter infection usually presents with fever and gastrointestinal symptoms, while neurological manifestations as presenting symptoms are extremely rare. Diagnosis is usually confirmed by stool culture. However, multiplex PCR is a more specific and sensitive method.

Case reports

We describe two unique cases of children presenting to the emergency department with fever, headache, mild nuchal rigidity and isolated elevated intracranial pressure (EIC) in lumbar puncture (LP). Gastrointestinal symptoms were evident on presentation in the first case and developed later in the second. Workup revealed elevated inflammatory markers and normal brain imaging.

Both cases were eventually positive for Campylobacter Jejuni by Multiplex PCR while cultures were negative, and made complete recovery after treatment with Azithromycin.

Discussion

There are few publications connecting Campylobacter infection to nuchal rigidity or EIC as presenting signs. Wright et al reported two cases of patients presenting with fever, abdominal pain and nuchal rigidity, however their LP was normal. EIC was reported as a late-onset complication secondary to Campylobacter infection, subsequently diagnosed as Miller-Fisher syndrome, though never during the acute phase. Levy et al presented a case of acute encephalopathy with EIC in a child with Campylobacter enteritis, suggesting these effects may be mediated by a neurotoxin, similar to the process caused by Shigella.

To the best of our knowledge, these are the first two cases of Campylobacter infections presenting with nuchal rigidity and EIC during the acute phase of illness, highlighting the importance of considering Campylobacter infections while treating children presenting with meningeal signs and gastrointestinal symptoms.