Case Report: Early non-convulsive status epilepticus in a preterm infant with recurrent refractory Escherichia coli meningitis complicated by intracranial abscess.

Here, we describe a male preterm infant born at 34+5 weeks of gestation with a birth weight of 2,390 g. At 8 days of age, he was admitted with jaundice and intermittent moaning and was diagnosed with neonatal bacterial meningitis due to Escherichia coli, accompanied by early non-convulsive status epilepticus (NCSE). The infant received meropenem for antimicrobial therapy and phenobarbital for seizure control. Following clinical stabilization and normalization of inflammatory markers, he was discharged. However, he subsequently developed recurrent fever and signs of disease relapse. Cerebral magnetic resonance imaging (MRI) performed during the third readmission revealed focal intracranial abscess that had not been detected on earlier imaging studies. Notably, culture of the abscess material yielded E. coli with an antimicrobial susceptibility profile identical to that of the initial cerebrospinal fluid isolate, confirming true relapse rather than reinfection. Surgical evacuation was performed, followed by a complete course of antibiotic therapy. The infant's symptoms resolved, and he was eventually discharged in stable condition. This case suggests that early NCSE in the acute phase of neonatal E. coli meningitis may be associated with a refractory, relapse-prone course.