Illustrative CasesIsolated Oculomotor Nerve Palsy A Unique Presentation of Haemophilus influenzae Type A MeningitisLatuska, Richard F. MD; Otillio, Jaime K. MDAuthor Information From the Department of Pediatric Emergency Medicine, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN. Disclosure: The authors declare no conflict of interest. Reprints: Richard F. Latuska, MD, Monroe Carell Jr. Children's Hospital at Vanderbilt, 2200 Children's Way, Nashville, TN 37232 (e-mail: [email protected]). Pediatric Emergency Care: March 2020 - Volume 36 - Issue 3 - p e172-e174 doi: 10.1097/PEC.0000000000002054 Buy Metrics Abstract In this case report, we describe a unique case of Haemophilus influenzae type A meningitis in a 7-month-old previously healthy girl that presented with an isolated cranial nerve (oculomotor) palsy without other signs and symptoms classically associated with this entity such as fever, meningismus, or a generally ill appearance. Oculomotor nerve abnormalities are rare in pediatrics. Congenital oculomotor palsy is the most common cause followed by trauma, infection, inflammatory conditions, neoplasm, aneurysm or other vascular events, and ophthalmoplegic migraines, respectively. Therefore, had it not been for the unusual magnetic resonance imaging findings identified in this patient prompting an extensive infectious workup with lumbar puncture, the diagnosis and treatment of meningitis may have been delayed further or missed all together. This fact emphasizes the importance of maintaining a broad differential when children present with neurologic abnormalities such as cranial nerve palsies. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.