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Subhyaloid or subinternal limiting membrane haemorrhage in meningococcal meningitis

Editor,—Subhyaloid or subinternal limiting membrane haemorrhage (sub-ILM) is usually caused by diabetic retinopathy,1 hypertensive retinopathy,2retinal artery macroaneurysm,2 Valsalva retinopathy,3 Terson's syndrome,2 or blood dyscrasias.4 Bacterial meningitis has been associated with subhyaloid or sub-ILM haemorrhage.5 6 We report a case of subhyaloid or sub-ILM haemorrhage in a young boy with meningococcal meningitis, and discuss the possible mechanisms and the management of this condition.

### CASE REPORT

A 13 year old boy was admitted to the paediatric ward with a 24 hour history of progressive drowsiness, headache, neck stiffness, nausea, and vomiting. On examination, he was confused, agitated, and pyrexial. There were petechial skin haemorrhages on both arms and legs. The blood pressure was normal and all peripheral pulses were present. There were no focal neurological signs. Funduscopy showed no obvious abnormalities. Lumbar puncture was contraindicated because of the …