3.1 Case 1: Gorham-Stout Disease
An 8-year-old male presented with chronic headaches and history of 5 episodes of meningitis caused by Streptococcus viridans orpneumoniae . Past medical history included refractory immune thrombocytopenia (ITP) which resolved after splenectomy. He was diagnosed with “lymphangiomatosis” at an outside institution and initially treated with propranolol and vincristine, and then briefly with sirolimus. All medications were stopped when he developed meningitis. After additional episodes of meningitis, he was referred to our institution. He suffered from daily debilitating headaches initially thought to be secondary to past meningitis infections. MRI of the brain and conventional CT of the head were not able to identify the source of his recurrent meningitis. CT cysternogram demonstrated an active CSF leak at the central skull base due to osseous erosion of lateral walls of the sphenoid sinuses (Figure 1A-D) . Comprehensive imaging showed extensive spinal involvement (Figure 1E) , lytic humeri lesions and a mediastinal LM. Since blood patch was unable to be performed due to the location and size of the dura mater defect, patient was initiated on interferon and zoledronic acid. After two years meningitis recurrence, interferon was stopped and oral sirolimus was started.