Meningitis misdiagnosis?

[Louis Balfour]

One of my children has just started uni and, a few days ago, was admitted to Coventry hospital with a non-blanching rash, abdominal pain and vomiting amidst a very heavy "cold". I thought it was meningitis.

The consultant said the virus was a side show and the actual problem was appendicitis. An op must be performed.

Due to the emergency list being long the op wasn't performed and more bloods were taken the next day. Eventually they started to doubt the appendicitis diagnosis.

IV antibiotics were given and they've were on a a fluids drip for several days.

The child has been discharged with antibiotics (co-amoxiclav) and painkillers.

I have just read that misdiagnosis of meningitis can often result in appendectomy. Furthermore that meningitis is a common "fresher" issue.

If this was / is meningitis is co-amoxiclav the cure? I am wondering whether I need to seek a second opinion.

Any medics here able to comment?

Edited by Louis Balfour on Saturday 19th October 10:49

[jackh707]

There's a difference between meningococcal septicaemia which traditionally gives you your non blanching rash and Meningitis, which on its own doesn’t necessarily give you a rash.

Theres loads of different types of non blanching rashes, those that can mimic your meningococcal sepsis rash, septic embolism showering, HSP, DIC etc.
And less worrying rashes like those due to forceful coughing and viruses.

Did he have an LP? That’s your only way to really rule in or rule out Meningitis.

Regardless, I doubt anyone on here can tell you if your family member had Meningitis or not unless they had seen them at the time with their bloods and LP results etc.

If he’s unwell and you are worried the safe thing to do is seek a second medical opinion which is very easily done

[Louis Balfour]

jackh707 said:

There's a difference between meningococcal septicaemia which traditionally gives you your non blanching rash and Meningitis, which on its own doesn’t necessarily give you a rash.

Theres loads of different types of non blanching rashes, those that can mimic your meningococcal sepsis rash, septic embolism showering, HSP, DIC etc.
And less worrying rashes like those due to forceful coughing and viruses.

Did he have an LP? That’s your only way to really rule in or rule out Meningitis.

Regardless, I doubt anyone on here can tell you if your family member had Meningitis or not unless they had seen them at the time with their bloods and LP results etc.

If he’s unwell and you are worried the safe thing to do is seek a second medical opinion which is very easily done

Thank you

If you mean lumbar puncture then no.

They are feeling a bit better but still with abdominal pain and very easily tired.

[Badda]

Not much more to add to Jack but the infamous non blanching rash is a late sign in meningococcal septicaemia and the only times I’ve seen it, the patient has been incredibly sick prior to its arrival. However its reputation quite rightly terrifies.

[Louis Balfour]

Badda said:

Not much more to add to Jack but the infamous non blanching rash is a late sign in meningococcal septicaemia and the only times I’ve seen it, the patient has been incredibly sick prior to its arrival. However its reputation quite rightly terrifies.

The child had flu-like symptoms for a week prior. Unable to function. Then the rash, agonising abdominal pain and vomiting.

We are of the view that if they continue to recover it doesn't very much matter what it was.It appears that it wasn't appendicitis however.

[Badda]

They’re no longer a child LB!

Sorry by incredibly sick I mean someone who probably needs to be in ICU promptly, deranged and septic af.

[Louis Balfour]

Badda said:

They’re no longer a child LB!

Sorry by incredibly sick I mean someone who probably needs to be in ICU promptly, deranged and septic af.

Legally maybe an adult. But they are a child.

When it all kicked off, they couldn't call me themselves because they were too confused. Someone called 999 and was told the ambulance would be between ten minutes and many hours arriving. So I suggested Uber, which was two minutes away.

Cov A&E said they faced a ten-hour wait. But when they were outside vomiting someone twigged that something was seriously amiss and took them straight in.

I managed to make it over there in time for the doctor's visit. The doc said they were sure it was appendicitis. So sure that no scan was required.

I don't know what the IV antibiotic was. But I am hoping it would have dealt with whatever it was. The rash faded over 24 hours.

Today is day five or six after the onset and they appear improved, but like something quite bad has happened.

In terms of a second opinion, if required. GP? Local A&E?

[Bill]

What do you hope to achieve with a second opinion?

It seems unlikely that anyone's going to do an LP on someone improving. It's not risk free and has potential to cause meningitis itself, and post LP headaches are no fun either. I had one and it left me unable to be upright for the best part of a fortnight!

[Louis Balfour]

Bill said:

What do you hope to achieve with a second opinion?

It seems unlikely that anyone's going to do an LP on someone improving. It's not risk free and has potential to cause meningitis itself, and post LP headaches are no fun either. I had one and it left me unable to be upright for the best part of a fortnight!

If improvement continues, there is nothing to be gained by seeking a second opinion. But they still seem quite ill and we don't get the sense that they are in the clear yet.

I think the comment about a lumbar puncture ^^^ was more saying "you'll never know" than a suggestion that having one would be a good idea.

[Bill]

You're probably better thinking of it as ongoing care then and get them in with a GP if improvement stalls.

[Louis Balfour]

Bill said:

You're probably better thinking of it as ongoing care then and get them in with a GP if improvement stalls.

Agreed.

There is also the benefit that, of they relapse whilst at home, they can go to our local hospital as opposed to a distant one.

[moffspeed]

Did the rash appear after the vomiting started ?

Vigorous vomiting can cause a “petechial” rash over the face/upper body.

[Louis Balfour]

moffspeed said:

Did the rash appear after the vomiting started ?

Vigorous vomiting can cause a “petechial” rash over the face/upper body.

I wasn't there. I think the rash came before the vomiting.

[sjabrown]

There are other reasons for non-blanching rash other than meningitis. As someone said above non-blanching rash in meningitis is often a late, and bad, sign and can be associated with septicaemia and disseminated intravascular coagulation.

Meningitis is not a single condition but a name for many. Bacterial meningitis is what scares folk but there are also many viral causes.

Other causes for non-blanching rashes include viral illnesses variously, henoch-schonlein purpura, immune thrombocytopaenia.

Likely little to be gained from seeking a second opinion if the person is improving. Difficult to say if co-amoxiclav has helped or not. And to further muddy waters some appendicitis does settle spontaneously - they don't all end up being taken out.

[Louis Balfour]

sjabrown said:

There are other reasons for non-blanching rash other than meningitis. As someone said above non-blanching rash in meningitis is often a late, and bad, sign and can be associated with septicaemia and disseminated intravascular coagulation.

Meningitis is not a single condition but a name for many. Bacterial meningitis is what scares folk but there are also many viral causes.

Other causes for non-blanching rashes include viral illnesses variously, henoch-schonlein purpura, immune thrombocytopaenia.

Likely little to be gained from seeking a second opinion if the person is improving. Difficult to say if co-amoxiclav has helped or not. And to further muddy waters some appendicitis does settle spontaneously - they don't all end up being taken out.

Thank you.

The rate of improvement appears very slow. Yesterday they were still taking painkillers for gut pain.

I usually find that medical stuff that is going to work usually works quite quickly. But this being a fresher I appreciate that they have potentially been exposed to something horrible from a foreign country. I remember when I was at uni contracting all manner of horrific infections.

[Terminator X]

Perhaps o/t but my (elderly) Dad ended up in Hospital for about 6 months although in the first few weeks he had a "raging" infection that the staff were bizarrely unable to diagnose; he was given multiple types of ABacs on a regular basis in the random hope that one would help. They never did work out what it was although it did eventually fade. Over a year later though they now think that he did have a brain infection as it has messed up his short term memory which is now very bad.

Only tell this as a warning to not necessarily trust what is being said.

TX.

[Louis Balfour]

I've just been to see the patient and their abdomen is still quite sore on the right, when pressed. "Not significantly less sensitve" was their comment. This is approaching a week after onset of the abdominal pain and vomiting, about two weeks after the heavy cold / virus started.

Leave it be? Call 111 for further advice? See the GP? Not Sure what to do.

[geeks]

sjabrown said:

And to further muddy waters some appendicitis does settle spontaneously - they don't all end up being taken out.

I am one of those people, was taken into A£E when I was about 10 with what the home visit doc on call (remember those?) was certain was appendicitis, I had pain in at McBurney's point (I still remember to this day some 30 years later him explaining this to me) docs in the hospital all agreed appendicitis, was scheduled to have it removed in a day or two, I went to bed and felt a bit better in the morning and by the evening they had sent me home. Think they called it grumbly appendix or something. I do remember the pain and all the other symptoms quite well though, not something I wish to repeat!

[Louis Balfour]

Called 111, who wanted us to speak to GP, who wants us to go back to A&E tomorrow.

[TownIdiot]

Louis Balfour said:

Called 111, who wanted us to speak to GP, who wants us to go back to A&E tomorrow.

Why not just got to a private walk in centre and get them to do some tests and give you an opinion?

Even a private GP.