Objective:

To report a case of persistent meningeal enhancement following culture-negative bacterial meningitis in an infant and to systematically review existing literature on the topic.

Approach:

• Case Presentation: A 70-day-old male infant with culture-negative bacterial meningitis exhibited 5 months of persistent meningeal enhancement on MRI after clinical recovery, following a standardized antimicrobial therapy.

Key Findings:

• The infant showed complete clinical recovery but persistent meningeal enhancement on MRI for 5 months, which may be misinterpreted as treatment failure.
• Neurodevelopmental assessment indicated age-appropriate performance with no neurological sequelae.
• Persistent meningeal enhancement may represent a benign post-inflammatory repair process, but further studies are needed to confirm this.

Interpretation:

Asymptomatic persistent meningeal enhancement after culture-negative bacterial meningitis may not necessarily indicate treatment failure or infection relapse, but further investigation is warranted.

Limitations:

• Limited long-term follow-up data on asymptomatic persistent meningeal enhancement in infants.
• Potential for misinterpretation of isolated MRI findings leading to overtreatment.

Conclusion:

Integrated clinical, laboratory, and imaging assessments are essential for accurate diagnosis and management of persistent meningeal enhancement in infants, to avoid misinterpretation of imaging findings.