Hot Seat #165: Denouement

Posted on: February 4, 2021, by :

The case: 7 yo transferred from an OSH for r/o meningitis with hypotension

Here is the case with answers to the questions.


n a patient with concern for sepsis vs meningitis vs appendicitis, most were in agreement that antibiotics, and pressers were indicated. The time at which pressors were indicated differed, some would recommend a third bolus while the patient is at the outside hospital ED, while others would start vasoactive agents. 

Dr. Agrawal brought up a good point that this patient is likely low risk for bacterial meningitis using this validated score.

Denouement: He was continued on ceftriaxone and vancomycin and admitted to the PICU, where BiPAP was initiated for worsening hypoxic respiratory failure. He underwent an extensive work-up that results negative. He was diagnosed with MIS-C (neurologic/pulmonary/GI) and started on appropriate treatment, later to be discharged home.

The information in these cases has been changed to protect patient identity and confidentiality. The images are only provided for educational purposes and members agree not to download them, share them, or otherwise use them for any other purpose.

Mary Beth Howard
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