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Biot’s breathing associated with acute bacterial meningitis in a child
  1. Alex Guri1,
  2. Eric Scheier1,
  3. Meital Adi2,
  4. Mikhael Chigrinsky3
  1. 1Paediatrics, Kaplan Medical Center, Rehovot, Israel
  2. 2Radiology, Kaplan Medical Center, Rehovot, Israel
  3. 3Paediatric Intensive Care Unit, Kaplan Medical Center, Rehovot, Israel
  1. Correspondence to Dr Alex Guri, alexgur{at}clalit.org.il

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A 19-month-old boy presented to the emergency room of our hospital with fever and drowsiness following asymmetric focal seizure. On examination the patient was somnolent, had signs of meningeal irritation and intermittent nystagmus. Laboratory examination revealed increased C-reactive protein (200 mg/L), procalcitonin (25.9 ng/mL) and hyponatraemia (132 mEq/L). The initial CT of the brain was normal. Given presumed meningoencephalitis, intravenous dexamethasone, vancomycin, ceftriaxone and acyclovir treatment was started, and the child was admitted to the paediatric intensive care unit. Several hours after the admission, irregular, jerky respirations appeared, consistent with Biot’s breathing (figure 1). The patient developed hypertension (129/90 mm Hg) and relative bradycardia (90 bpm). Due to these signs, consistent with increased intracranial pressure, lumbar puncture was deferred and the child received mannitol with notable improvement in his condition. On hospital day 2, lumbar puncture revealed turbid fluid with an opening pressure of 5 cmH2O, white …

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