Dermal sinus tracts

### What you need to know A newborn boy was noted to have a high-lying pit above the natal cleft with surrounding hair (fig 1). The family were reassured by their primary care doctor, and no further investigation was performed. Fig 1 Photograph of patient’s lumbosacral region showing the small dermal sinus ostium in the sacral region with associated hair follicles. Given its low location, and the presence of only a small amount of hair, it is clear how this may have been mistaken for a benign coccygeal dimple. However, the associated cutaneous markers (hair follicles) and that the bottom of the lesion could not be clearly seen are the indicators that this is not an innocent lesion At age 4 months, the boy presented with fever and vomiting to his local emergency department and was discharged with a diagnosis of suspected viral gastroenteritis. When he developed additional irritability, photophobia, and worsening pyrexia, lumbar puncture confirmed Escherichia coli meningitis, and the patient was started on intravenous antibiotics. Clinical examination and magnetic resonance imaging (MRI) of the spine confirmed a lumbosacral dermal sinus tract with signs of associated infection of the cerebrospinal fluid (arachnoiditis around the cauda equina which had spread cranially, causing meningitis) (fig 2). After the infection had been treated with intravenous antibiotics, the …