Instructive CasesRecurrent Pneumococcal Meningitis Secondary to Nasoethmoidal MeningoceleTaylor, Amanda MBChB*; van der Meer, Graeme MBChB, MMed†; Perry, David MBChB, FRANZCR‡; Best, Emma MBChB, FRACP§; Webb, Rachel MBChB, FRACP¶Author Information From the *Department of Paediatric Medicine, Kidz First Children's Hospital, Counties Manukau District Health board, Auckland, New Zealand †Department of Otorhinolaryngology, Starship Children's Hospital, Auckland District Health board, Auckland, New Zealand ‡Department of Paediatric Radiology, Starship Children's Hospital, Auckland District Health board, Auckland, New Zealand §Department of Paediatric Infectious Diseases, Starship Children's Hospital, Auckland District Health board, Auckland, New Zealand ¶Department of Paediatrics, University of Auckland, New Zealand. Accepted for publication September 30, 2019. The authors have no funding or conflicts of interest to disclose. Written consent obtained from all 3 families. Address for correspondence: Amanda Taylor, MBChB, Starship Children’s Health, Private Bag 92024, Auckland 1142, New Zealand. E-mail: ATaylor@adhb.govt.nz. The Pediatric Infectious Disease Journal: February 2020 - Volume 39 - Issue 2 - p e17-e19 doi: 10.1097/INF.0000000000002520 Buy Metrics Abstract Since the widespread introduction of the conjugate pneumococcal vaccine and subsequent decline of invasive pneumococcal disease in children, a significant proportion of children with pneumococcal meningitis are identified as having an underlying immunodeficiency or predisposing anatomic abnormality. We present 3 cases of recurrent pneumococcal meningitis where detailed neuro-imaging revealed subtle anterior base of skull defects not detected on initial investigations. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.