{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T15:05:57Z","timestamp":1784041557508,"version":"3.55.0"},"reference-count":41,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T00:00:00Z","timestamp":1783987200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Bacterial meningitis (BM) in infants may be complicated by persistent meningeal enhancement on magnetic resonance imaging (MRI) after clinical cure\u2014a phenomenon frequently misdiagnosed as infection recurrence. However, long-term follow-up data on asymptomatic persistent meningeal enhancement in young infants remain scarce. Here, we report a rare case of 5-month persistent meningeal enhancement following culture-negative bacterial meningitis (CNBM) in a 70-day-old infant, and systematically reviewed 17 eligible studies on meningeal enhancement in infantile bacterial meningitis published between 2014 and 2025 to provide comprehensive evidence for clinical practice.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>\n                      A 70-day-old male infant was admitted on March 22, 2025, with a 2-day history of fever. Laboratory findings were consistent with severe bacterial infection (C-reactive protein [CRP]: 116.16\u2005mg\/L, procalcitonin [PCT]: 0.535\u2005ng\/mL), and lumbar puncture confirmed central nervous system infection (cerebrospinal fluid [CSF] nucleated cell count: 376.0\u2009\u00d7\u200910\n                      <jats:sup>6<\/jats:sup>\n                      \/L, 76% neutrophils, protein: 0.86\u2005g\/L). Following standardized antimicrobial therapy with meropenem plus vancomycin (total 18-day course) and supportive care, the infant's clinical symptoms, CSF parameters, and systemic inflammatory markers normalized completely. However, contrast-enhanced cranial MRI demonstrated persistent meningeal enhancement for approximately 5 months (from March 27, 2025, to August 26, 2025), without evidence of cerebral parenchymal injury, hydrocephalus, or subdural effusion. Neurodevelopmental assessment using the Gesell Developmental Schedules revealed age-appropriate performance across gross motor, fine motor, language, and social domains, with no neurological sequelae.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Asymptomatic persistent meningeal enhancement after clinically diagnosed CNBM in young infants may represent a benign manifestation of delayed post-inflammatory repair when alternative etiologies and active infection have been reasonably excluded. Clinical decision-making should rely on comprehensive integration of clinical symptoms, laboratory parameters, and imaging findings to prevent overtreatment based solely on isolated MRI abnormalities. Given the diagnostic limitations inherent in culture-negative cases, long-term serial follow-up is essential to confirm the benign prognosis of such imaging findings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fped.2026.1799852","type":"journal-article","created":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T14:34:47Z","timestamp":1784039687000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Persistent meningeal enhancement on MRI in an infant with culture-negative bacterial meningitis: a case report and systematic review of the literature (2014\u20132025)"],"prefix":"10.3389","volume":"14","author":[{"given":"Qunyan","family":"Su","sequence":"first","affiliation":[{"name":"Department of Children\u2019s Internal Medicine, Taizhou Maternal and Child Health Hospital","place":["Taizhou City, 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Child Health Hospital","place":["Taizhou City, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anqian","family":"Tao","sequence":"additional","affiliation":[{"name":"Department of Children\u2019s Internal Medicine, Taizhou Maternal and Child Health Hospital","place":["Taizhou City, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guiying","family":"Ruan","sequence":"additional","affiliation":[{"name":"Department of Children\u2019s Internal Medicine, Taizhou Maternal and Child Health Hospital","place":["Taizhou City, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Licheng","family":"Cui","sequence":"additional","affiliation":[{"name":"Department of Children\u2019s Internal Medicine, Taizhou Maternal and Child Health Hospital","place":["Taizhou City, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yandan","family":"Yin","sequence":"additional","affiliation":[{"name":"Department of 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