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The report describes a female infant who developed recurrent febrile illnesses with suspected meningitis; cerebrospinal fluid showed pleocytosis with elevated protein and normal-to-low glucose, while Gram stains and cultures were repeatedly negative. Laboratory findings supported CGD via abnormal dihydrorhodamine oxidative burst testing and guided timely diagnostic and preventive management considerations.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/neonatal-onset-chronic-granulomatous-disease-presenting-with-recurrent-culture-negative-meningitis-a-case-report-and-diagnostic-considerations/454289/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/neonatal-onset-chronic-granulomatous-disease-presenting-with-recurrent-culture-negative-meningitis-a-case-report-and-diagnostic-considerations/454289.png","ImageObject",300,407,{"name":92,"@type":93},"Maya Linwood","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-07","2026-09-30",true,{"@type":102,"interactionType":103,"userInteractionCount":44},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"Why was the meningitis described as culture-negative, and what did the CSF show?","Question",{"text":112,"@type":113},"Across episodes, cerebrospinal fluid showed pleocytosis with elevated protein and normal-to-low glucose, while Gram stain and CSF cultures repeatedly returned negative results, consistent with recurrent culture-negative meningitis.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"How did the flow cytometry dihydrorhodamine (DHR) assay contribute to diagnosing CGD?",{"text":117,"@type":113},"A flow cytometric DHR oxidative burst assay showed a markedly abnormal response after stimulation, supporting the diagnosis of CGD.",{"name":119,"@type":110,"acceptedAnswer":120},"What treatment was given for the later urinary infection and what was the outcome?",{"text":121,"@type":113},"A sterile catheter urine culture grew multidrug-resistant Klebsiella pneumoniae with susceptibility limited to aminoglycosides; the patient was treated with amikacin for 10 days, with defervescence within 48 hours and a subsequent urine culture showing no growth.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},454289,1791010144,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":44,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":24,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":144,"preview_page_count":4},962084928432,"https://ap-avatar.wpscdn.com/davatar_155a257f0dc6eb9ab79c44ca47cae57d","Wiley  \nCase Reports in Immunology  \nVolume 2026, Article ID 1817159, 5 pages [https://doi.org/10.1155/crii/1817159](https://doi.org/10.1155/crii/1817159)  \nCase Report  \nNeonatal-Onset Chronic Granulomatous Disease Presenting With Recurrent Culture-Negative Meningitis: A Case Report and Diagnostic Considerations  \nAnwar Abu Hetta , 1,2 Rayyan G. Shakarnah ,3 Khalil R. Salah ,3 Jasem Y. Hroub ,3 Abdallah N. Khatib ,3 and Amjad H. Rabei 3  \n1Department of Pediatrics, Alia Governmental Hospital, Hebron, State of Palestine 2Faculty of Medicine, Palestine Polytechnic University, Hebron, State of Palestine  \n3Department of Clinical Medical Sciences, Faculty of Medicine and Health Sciences, Palestine Polytechnic University, Hebron, State of Palestine  \nCorrespondence should be addressed to Amjad H. Rabei; [200120@ppu.edu.ps](200120@ppu.edu.ps)[ ](200120@ppu.edu.ps)Received 10 October 2025; Revised 21 December 2025; Accepted 22 December 2025 Academic Editor: Xingliang Dai  \nCopyright © 2026 Anwar Abu Hetta et al. Case Reports in Immunology published by John Wiley & Sons Ltd. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.  \nChronic granulomatous disease (CGD) is a primary immunodeficiency caused by defective phagocyte oxidative burst and may present in early life with severe or recurrent infections. We report a female infant born at 38 weeks’ gestation (birth weight 2700g) who developed fever and presumed sepsis at 5 days of life, followed by multiple recurrent hospitalizations for febrile illness with suspected meningitis, diarrhea, dehydration, and failure to thrive. Cerebrospinal fluid (CSF) evaluations across episodes demonstrated pleocytosis with elevated protein and normal-to-low glucose, while Gram stain and CSF cultures were repeatedly negative, consistent with recurrent culture-negative meningitis. Laboratory assessment showed intermittent anemia, thrombocytosis, and episodes of significant neutropenia. Complement and immunoglobulin levels were within reference ranges, and flow cytometry demonstrated preserved T-and B-lymphocyte compartments. A flow cytometric dihydrorhodamine (DHR) oxidative burst assay was markedly abnormal (phorbol 12-myristate 13-acetate stimulation index 13%; Escherichia coli stimulation index 22.3%), supporting the diagnosis of CGD. At ~4.5 months of age, a sterile catheter urine culture grew multidrug-resistant Klebsiella pneumoniae at ≥100,000CFU/mL with susceptibility limited to aminoglycosides; the patient was treated with amikacin 15mg/kg/ dose intravenously once daily for 10 days, with defervescence within 48h, clinical recovery, and a repeat urine culture showing no growth. Genetic testing was not performed due to financial and social constraints, and longer-term outcomes beyond early infancy were unavailable in the record extract. This case underscores that recurrent culture-negative meningitis in early infancy should prompt evaluation for primary immunodeficiency and that early DHR testing can expedite CGD diagnosis and guide timely preventive management and specialist referral.  \nKeywords: case report; chronic granulomatous disease; culture-negative meningitis; dihydrorhodamine (DHR) test; primary immunodeficiency  \n1. Introduction  \nChronic granulomatous disease (CGD) is an inherited defect of the phagocyte NADPH oxidase complex that impairs therespiratory burst and predisposes affected children to severe, recurrent bacterial and fungal infections, alongside inflammatory complications [1] .  \nAlthough CGD is typically diagnosed in early childhood, symptomatic presentation in the neonatal period or early infancy is uncommon and may be misattributed to routine neonatal sepsis or meningitis, which can delay recognition of an underlying inborn error of immunity and timely preventive management [2, 3].  \n2 Case Reports in Immunology  \nRecurrent meningiti","cbCaiaocFAhgt8cT","https://ap.wps.com/l/cbCaiaocFAhgt8cT","pdf",374413,"English","# Introduction\n# Case Reports in Immunology\n## Case Presentation","[{\"question\":\"Why was the meningitis described as culture-negative, and what did the CSF show?\",\"answer\":\"Across episodes, cerebrospinal fluid showed pleocytosis with elevated protein and normal-to-low glucose, while Gram stain and CSF cultures repeatedly returned negative results, consistent with recurrent culture-negative meningitis.\"},{\"question\":\"How did the flow cytometry dihydrorhodamine (DHR) assay contribute to diagnosing CGD?\",\"answer\":\"A flow cytometric DHR oxidative burst assay showed a markedly abnormal response after stimulation, supporting the diagnosis of CGD.\"},{\"question\":\"What treatment was given for the later urinary infection and what was the outcome?\",\"answer\":\"A sterile catheter urine culture grew multidrug-resistant Klebsiella pneumoniae with susceptibility limited to aminoglycosides; the patient was treated with amikacin for 10 days, with defervescence within 48 hours and a subsequent urine culture showing no growth.\"}]","Neonatal-Onset Chronic Granulomatous Disease Presenting With Recurrent Culture-Negative Meningitis - A Case Report and Diagnostic Considerations | PDF",1790740442,13]