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An 8-week-old male infant presented with seizures (abnormal eye movements and posturing). Two weeks previously, he presented with a cough diagnosed as pertussis by nasopharyngeal aspirate PCR, and he received oral erythromycin for 7 days. Neither he nor his parents had received recent pertussis immunisation. At this presentation, nasopharyngeal aspirate PCR remained positive for Bordetella pertussis and was negative for other viruses including influenza. Additional investigations showed a lymphocytosis 18.2×109/l, normal inflammatory markers and sterile blood cultures. The cerebrospinal fluid (CSF) was acellular with normal glucose and elevated protein 1.2 g/l and was sterile on culture. CSF PCR for herpes simplex virus and enterovirus were negative. MRI of the brain showed caudate nucleus enhancement suggesting encephalitis (figure 1), a …
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