A previously healthy 4-year-old male presented with fever, headache, vomiting, and stiff neck after swimming in a splash pad. Initial lumbar puncture revealed pleocytosis, elevated protein, and low glucose, suggestive of bacterial meningitis. Despite broad-spectrum antibiotics, his condition rapidly deteriorated, progressing to coma. Brain imaging showed diffuse cerebral edema. Diagnostic testing on cerebrospinal fluid, including real-time PCR, confirmed the presence of Naegleria fowleri, leading to a diagnosis of primary amebic meningoencephalitis (PAM). The patient unfortunately succumbed to the infection. This case highlights the rapid and fatal course of PAM and the importance of early suspicion in patients with compatible exposure and symptoms.
Key note: Early consideration of Naegleria fowleri in suspected meningitis cases with freshwater exposure is critical for timely diagnosis and potential intervention.