# An Infant With COVID-19 Presenting With a Bulging Fontanel: A Case Report and Literature Review

## TL;DR

An infant with mild COVID-19 presented with a bulging fontanel, initially raising suspicion of bacterial meningitis, but tests ruled out serious infection.

## Contribution

Highlights the low specificity of bulging fontanel in infants with COVID-19 to avoid unnecessary antibiotic use.

## Key findings

- The infant showed no signs of bacterial meningitis despite a bulging fontanel.
- Fever resolved quickly, and the infant was discharged in good condition.
- Cerebrospinal fluid tests were normal, confirming no bacterial infection.

## Abstract

A bulging fontanel is a sign of elevated intracranial pressure, which can be caused by diseases with intracranial fluid retention or swelling of the cerebral parenchyma. We experienced a case of an infant with a typical course of mild coronavirus disease 2019 (COVID-19) but with a bulging fontanel as a finding at presentation. The patient, a three-month-old boy with no underlying conditions, presented to the emergency clinic with fever, vomiting, and loss of appetite. Due to the absence of crying and the bulging fontanel, he was referred to our hospital with suspected bacterial meningitis. The diameter of the anterior fontanel was 2.5 cm, as measured by the Popich and Smith method. He showed no signs of consciousness impairment and appeared to be as active as usual. Computed tomography revealed a bulging fontanel. Cerebrospinal fluid examination showed no elevated cell counts, and cultures were negative. Accordingly, bacterial meningitis was ruled out. The fever resolved on the day after admission, and the patient was discharged on the third day after admission in good general condition. When an infant diagnosed with COVID-19 presents with a bulging fontanel, it is important to be aware of its low specificity and excessive antibiotic treatment should be reconsidered.