# October 2026

- Link: https://isnr.in/october-2026/
- Published: 2026-10-10T11:15:12+05:30
- Author: ISNR

**CASE HISTORY**

• A 7-year-old girl was referred from IGICH with a 20-day history of headache, vomiting,
and fever, followed by altered sensorium. Initial evaluation at a local hospital
included lumbar puncture, which revealed hypoglycorrhachia (CSF glucose: 11 mg/dL)
and elevated CSF protein (160 mg/dL). CSF culture grew Kocuria rosea, and antibiotic
therapy was initiated.

• Her past history was significant for chronic diarrhea of 3 years’ duration and
esophageal candidiasis. Serum IgE levels were elevated, raising the suspicion of
an underlying hyper-IgE syndrome.

• Immunological profile: Markedly elevated serum IgE (~7,694 IU/mL), low serum IgM(
<16 mg/dL), and absolute lymphocyte count of ~1,240 cells/µL, raising suspicion 
for an underlying immunodeficiency, including hyper-IgE syndrome.

• On examination, the child was conscious and oriented (GCS: E4V5M6). Both pupils
were equal and reactive to light. Motor examination revealed reduced power in the
right upper limb (3/5) and right lower limb (4+/5), with power greater than 3/5 
in the left upper and lower limbs. Head circumference was 91.5 cm and mid-upper 
arm circumference (MUAC) was 13.5 cm. There was no history of loss of consciousness,
seizures, or limb weakness reported in the initial history.

• Neuroimaging raised initial suspicion of an infective lesion. Antitubercular therapy(
ATT) and dexamethasone were subsequently initiated.

• She underwent left frontal craniotomy with ultrasound-guided aspiration of the
suspected abscess on 23/08/2026, followed by re-exploration and resection on 27/
08/2026. In view of neurological deterioration, worsening cerebral edema, and midline
shift, she underwent extension of the craniotomy to a left frontotemporoparietal
decompressive craniectomy with right frontal external ventricular drain (EVD) placement
on 29/08/2026.

![](https://isnr.in/wp-content/uploads/2026/10/Picture-1-scaled.png)

![](https://isnr.in/wp-content/uploads/2026/10/Picture-2-scaled.png)

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