De novo subgaleal abscess - a rare presentation of melioidosis: a case report

De novo subgaleal abscess complicated by spontaneous osteomyelitis and epidural abscess: a case report and review of literature

Introduction and importance

A subgaleal abscess is a collection of pus in a potential space between the galea aponeurotica and pericranium. De novo subgaleal abscesses are a subset of subgaleal abscesses that develop in the absence of identifiable risk factors such as head trauma or procedures. However, these have rarely been reported in the literature.

Case presentation

We present the case of a 65-year-old woman who presented with a headache for two and a half months, followed by swelling of the right parieto-occipital scalp. She denied any history of trauma, procedures, or anticoagulant use. A diagnosis of subgaleal abscess complicated by osteomyelitis and epidural abscess was made after obtaining a computed tomography of the head. Surgical treatment consisting of drainage, debridement, and craniectomy was performed, and the disease was successfully treated with a 6-week course of antibiotics.

Clinical discussion

It is uncommon to have a de novo subgaleal abscess with spontaneous osteomyelitis and an epidural abscess as concurrent complications. The symptoms can be subtle, such as chronic headaches which can lead to delayed hospital visits. Computed tomography of the head is sufficient to make a definitive diagnosis. Appropriate antibiotic therapy and surgical intervention are necessary, which may encompass incision, drainage, debridement, and occasionally a craniectomy in order to achieve full resolution.

Conclusions

One should be vigilant when evaluating scalp swelling for possible underlying abscesses. Prompt diagnosis and appropriate surgical treatment with adequate antibiotics are preferred treatment options for de novo subgaleal abscesses.

Subgaleal Abscess Following Staphylococcal Cellulitis in a 10-Month-Old Child: A Diagnostic Challenge for the Clinician

Subgaleal abscess is an extremely rare and unusual presentation of head and neck infections and has been reported to occur following scalp infections, head trauma, sinusitis, septicemia, scalp monitoring, and surgical interventions. We report a 10-month-old child who presented with cellulitis around a pustule on the right forehead of three days duration. It was initially treated with oral cloxacillin for five-days. However, the child went on to develop a high continued fever on the day of discharge and remained febrile and unwell for seven days until a subgaleal abscess was identified and surgical drainage was performed. Pus cultures grew Staphylococcus aureus, which was sensitive to flucloxacillin. Following drainage of the abscess and change of antibiotics to intravenous flucloxacillin, fever completely subsided and the child made a complete clinical recovery. This report highlights the importance of having a high clinical suspicion of this rare complication in children with continuing high spikes of temperature following skin infections in the head region.

Spontaneous Subgaleal Abscess Associated with Lung Adenocarcinoma: First Description of This Unusual Association

BACKGROUND

Primary, spontaneous, or de novo subgaleal abscesses represent extremely rare lesions usually related to patients with risk factors and predisposing conditions for infections. They are associated with high morbidity, and a proper diagnosis can be misleading. To the best of our knowledge, this is the first reported case of a de novo subgaleal abscess not related to previous traumatic head injury and associated with lung adenocarcinoma.

CASE DESCRIPTION

A 59-year-old man was admitted to our unit because he presented fever and a palpable subcutaneous right parietal mass. No history of traumatic head injury was mentioned. The patient underwent needle aspiration of the subgaleal lesion for microbiological, histological, and cytological examination, with negative response. Chest radiograph and then thoracic computed tomography scan revealed the presence of 2 lesions in the left lung. Complete removal with surgical debridement of the parietal bone lesion was performed due to the suspicion of an abscessualized skull metastasis from a primary lung adenocarcinoma.

CONCLUSIONS

We strongly suggest a patient global assessment in the event of subgaleal abscess without history of traumatic head injury, to treat eventual associated findings as soon as possible.