Adrenal Abscess—The Hidden Culprit in a Neonate with Meningitis

Adrenal abscess in newborns is a rare clinical entity and can be easily missed. Here we present a case of adrenal abscess in a baby with extensively drug-resistant (XDR) meningitis. A term female baby without any significant medical history developed XDR Klebsiella pneumoniae meningitis and was treated with appropriate antibiotics. Even on antibiotic treatment, she was found to have persistently elevated C-reactive protein titer, which on evaluation showed right adrenal abscess as the hidden culprit. Right adrenal abscess was drained with pigtail catheter, and subsequently her C-reactive protein titer was normalized and the neonate was discharged on stable vitals. Newborns with persistently elevated inflammatory markers with unusual clinical picture can have hidden infections like adrenal abscess. Timely identification and management of adrenal abscess are important in preventing morbidity and mortality.