Rafael Figueiredo - Department of Pediatrics, Centro Materno-Infantil do Norte Albino Aroso, Centro Hospitalar Universitário do Porto, Porto, Portugal.
Joana Soares - Department of Pediatrics, Centro Hospitalar do Tâmega e Sousa, Penafiel, Portugal.
Alzira Sarmento - Department of Neonatal and Pediatric Intensive Care, Centro Materno-Infantil do Norte Albino Aroso, Centro Hospitalar Universitário do Porto, Porto, Portugal.
Paula Ferreira - Department of Neonatal and Pediatric Intensive Care, Centro Materno-Infantil do Norte Albino Aroso, Centro Hospitalar Universitário do Porto, Porto, Portugal.

Group A Streptococcus (GAS) can cause invasive disease but rarely causes meningitis. Here we report a three-year-old girl with a GAS meningitis after Arnold-Chiari type I corrective surgery. Six days after surgery she presented fever, headache, vomiting and surgical wound inflammatory signs. A cerebrospinal fluid (CSF) collection with a fistulous path to skin was identified and GAS was found in blood and CSF cultures. Despite targeted antibiotherapy, due to lack of improvement and difficult management of the CSF fistula, she needed to be submitted to several surgical corrections and increased antibiotherapy spectrum. Despite the low risk in acquiring bacterial meningitis after neurosurgery, these procedures may be a direct route for infection. Surgery complications like a fistula are a known risk factor for infection and although uncommon, GAS meningitis may be difficult to manage and can cause serious morbidity.

Arnold-Chiari type I malformation surgery, Group A Streptococcus invasive disease, Group A Streptococcus meningitis