The number of studies about recurrent bacterial meningitis (RBM) diagnostic challenge in children is limited. Structural approach and early diagnosis of an underlying pathology are crucial to prevent further episodes and improve the overall outcome [1]. 1.3% of children with bacterial meningitis had experienced at least one previous episode. Anatomic abnormalities are the most common predisposing factor for RBM, and congenital inner ear malformation is the leading cause [2]. Acquired immune deficiency (HIV) forms an important cause of RBM in some areas [22]. Terminal Complement defect is the leading congenital immunodeficiency that may cause RBM [1]. History of head trauma is an important factor but should not lead to exclude other important factors. Isolation of a specific bacterial organism can guide the diagnostic approach. We want to report a case of recurrent bacterial meningitis in a 12 year old boy with a small nasal ethmoidal CSF- leak fistula activation after 6 years of a head trauma. A diagnostic approach has been suggested depending on review of many trusted studies and clinical experiences.
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