Streptococcal meningitis with an unusual port of entry.

An 18-month-old boy developed meningitis due to group A beta-hemolytic Streptococcus. Despite adequate antibiotic therapy with aqueous sodium penicillin G and chloramphenicol for more than eight weeks, he showed persistent abnormal spinal fluid findings, recurrent elevations of temperature, irritability, and poor feeding. Further investigation revealed a congenital dermal sinus of the nose, with an entry into the anterior fossa that made a small opening intradurally at the level of the cribiform plate. Surgical removal of the entire sinus tract resulted in a speedy and complete recovery.