The Rare Co-occurrence of Clostridioides difficile Infection and Pseudomonas Meningitis in an Infant: A Case Report

Abstract

This case report presents a five-month-old infant who developed clinically manifested Clostridioides difficile (C. difficile) infection (CDI) and Pseudomonas aeruginosa (P. aeruginosa) meningitis. Initially diagnosed with pseudomembranous enterocolitis and treated with oral vancomycin, the child showed gastrointestinal improvement but continued to experience persistent fever, prompting further evaluation. Neuroimaging revealed ventriculomegaly, leading to a lumbar puncture that confirmed bacterial meningitis. Empiric antibiotics were initiated, and amikacin was added following CSF culture results that identified P. aeruginosa, resulting in significant clinical improvement. This report highlights the diagnostic challenges of P. aeruginosa meningitis in infants, particularly when complicated by secondary infections like CDI. Our objective is to raise awareness about the fact that although P. aeruginosa meningitis is extremely rare in the pediatric population and CDI is infrequently symptomatic in infants, early recognition and aggressive treatment can improve outcomes and reduce complications.

Keywords: clostridioides difficile infection; gram negative meningitis; pediatric gastroenterology; pediatric infectious disease; pseudomonas aeruginosa meningitis.

Figure 1. CT of the head showing ventriculomegaly

CT: computed tomography