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Munekata Y, Yamamoto S, Kato S, Kitagawa Y, Enda K, Okazaki N, Tanikawa S, Tanei ZI, Ikebe Y, Osawa T, Takamiya S, Ujiie H, Onozawa M, Hirano S, Fujimura M, Tanaka S. Fatal case of subdural empyema caused by Campylobacter rectus and Slackia exigua. Autops Case Rep 2023; 13:e2023433. [PMID: 37415644 PMCID: PMC10321782 DOI: 10.4322/acr.2023.433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 04/28/2023] [Indexed: 07/08/2023]
Abstract
We report a fatal subdural empyema caused by Campylobacter rectus in a 66-year-old female who developed acute onset of confusion, dysarthria, and paresis in her left extremities. A CT scan showed hypodensity in a crescentic formation with a mild mid-line shift. She had a bruise on her forehead caused by a fall several days before admission, which initially raised subdural hematoma (SDH) diagnosis, and a burr hole procedure was planned. However, her condition deteriorated on the admission night, and she died before dawn. An autopsy revealed that she had subdural empyema (SDE) caused by Campylobacter rectus and Slackia exigua. Both microorganisms are oral microorganisms that rarely cause extra-oral infection. In our case, head trauma caused a skull bone fracture, and sinus infection might have expanded to the subdural space causing SDE. CT/MRI findings were not typical for either SDH or SDE. Early recognition of subdural empyema and prompt initiation of treatment with antibiotics and surgical drainage is essential for cases of SDE. We present our case and a review of four reported cases.
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Affiliation(s)
- Yuki Munekata
- Hokkaido University Hospital, Clinical Training Center, Sapporo, Japan
| | - Saki Yamamoto
- Hokkaido University Hospital, Clinical Training Center, Sapporo, Japan
| | - Shun Kato
- Hokkaido University Hospital, Clinical Training Center, Sapporo, Japan
| | - Yutaro Kitagawa
- Hokkaido University Hospital, Clinical Training Center, Sapporo, Japan
| | - Ken Enda
- Hokkaido University Hospital, Clinical Training Center, Sapporo, Japan
| | - Nanase Okazaki
- Hokkaido University Hospital Department of Surgical Pathology, Sapporo, Japan
| | - Satoshi Tanikawa
- Hokkaido University, Institute of Chemical Reaction Design and Development (WPI-ICReDD), Sapporo, Japan
| | - Zen-ichi Tanei
- Hokkaido University, Faculty of Medicine, Department of Cancer Pathology, Sapporo, Japan
| | - Yohei Ikebe
- Hokkaido University, Faculty of Medicine, Center for Cause of Death Investigation, Sapporo, Japan
| | - Takahiro Osawa
- Hokkaido University Hospital, Department of Renal and Genitourinary Surgery, Sapporo, Japan
| | - Soichiro Takamiya
- Hokkaido University Hospital, Department of Neurosurgery, Sapporo, Japan
| | - Hideki Ujiie
- Hokkaido University Hospital, Clinical Training Center, Sapporo, Japan
| | - Masahiro Onozawa
- Hokkaido University Hospital, Clinical Training Center, Sapporo, Japan
| | - Satoshi Hirano
- Hokkaido University Hospital, Clinical Training Center, Sapporo, Japan
| | - Miki Fujimura
- Hokkaido University Hospital, Department of Neurosurgery, Sapporo, Japan
| | - Shinya Tanaka
- Hokkaido University, Institute of Chemical Reaction Design and Development (WPI-ICReDD), Sapporo, Japan
- Hokkaido University, Faculty of Medicine, Department of Cancer Pathology, Sapporo, Japan
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Yang RX, Chen B, Zhang Y, Yang Y, Xie S, He L, Shi J. Development of subdural empyema from subdural effusion after suppurative encephalitis: A case report. World J Clin Cases 2023; 11:2315-2320. [PMID: 37122516 PMCID: PMC10131016 DOI: 10.12998/wjcc.v11.i10.2315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 02/18/2023] [Accepted: 03/10/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND Chronic subdural effusion is very common in the cranial imaging of middle-aged and older people. Herein, we report a patient misdiagnosed with subdural effusion, who was eventually diagnosed with chronic subdural empyema (SDE) caused by Streptococcus pneumoniae.
CASE SUMMARY A 63-year-old man was brought to our emergency room with a headache, vomiting, and disturbed consciousness. Computed tomography (CT) revealed a bilateral subdural effusion at the top left side of the frontal lobe. Cerebrospinal fluid examination after lumbar puncture indicated suppurative meningitis, which improved after anti-infective therapy. However, the patient then presented with acute cognitive dysfunction and right limb paralysis. Repeat CT showed an increase in left frontoparietal subdural effusion, disappearance of the left lateral ventricle, and a shift of the midline to the right. Urgent burr hole drainage showed SDE that was culture-positive for Streptococcus pneumoniae. His condition improved after adequate drainage and antibiotic treatment.
CONCLUSION Patients with unexplained subdural effusion, especially asymmetric subdural effusion with intracranial infection, should be assessed for chronic SDE. Early surgical treatment may be beneficial.
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Affiliation(s)
- Rui-Xi Yang
- Department of Infectious Diseases, Mianyang Central Hospital, Mianyang 621000, Sichuan Province, China
| | - Bei Chen
- Department of Psychosomatic Medicine, Mianyang Central Hospital, Mianyang 621000, Sichuan Province, China
| | - Yun Zhang
- Department of Psychosomatic Medicine, Mianyang Central Hospital, Mianyang 621000, Sichuan Province, China
| | - Yao Yang
- Department of Psychosomatic Medicine, Mianyang Central Hospital, Mianyang 621000, Sichuan Province, China
| | - Shu Xie
- Department of Psychosomatic Medicine, Mianyang Central Hospital, Mianyang 621000, Sichuan Province, China
| | - Lin He
- Department of Psychosomatic Medicine, Mianyang Central Hospital, Mianyang 621000, Sichuan Province, China
| | - Jian Shi
- Department of Psychosomatic Medicine, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang 621000, Sichuan Province, China
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