Salmonella Group D1 Subdural Empyema Mimicking Subdural Hematoma: A Case Report

Subdural empyema is caused by various pathogens. The most typical clinical presentation may include fever, headache, seizures, and altered consciousness. However, Salmonella infections are relatively rare. Representative features of Salmonella infection include fever and gastrointestinal symptoms su...

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Bibliographic Details
Published in:Infection and drug resistance 2022-01, Vol.15, p.6357-6363
Main Authors: Lu, Hao-Fang, Yue, Chung-Tai, Kung, Woon-Man
Format: Article
Language:English
Subjects:
Abscesses
Antibiotics
Blood
Brain
Brain injury
Case Report
Case reports
Ceftriaxone
Central nervous system
Consciousness
Diagnosis
Diarrhea
Drug resistance
Dura mater
Ear diseases
Emergency medical care
Empyema
Fever
Head injuries
Headache
Headaches
Hematoma
Intravenous administration
Magnetic resonance imaging
Medical imaging
Meninges
Neuroimaging
Neurological diseases
Neutrophils
Pathogens
Patients
Salmonella
Seafood
Seizures
Sinusitis
Streptococcus infections
subdural
Subdural empyema
Surgery
Tomography
Vomiting
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Summary:Subdural empyema is caused by various pathogens. The most typical clinical presentation may include fever, headache, seizures, and altered consciousness. However, Salmonella infections are relatively rare. Representative features of Salmonella infection include fever and gastrointestinal symptoms such as diarrhea, vomiting, and abdominal cramping pain. Extra-gastrointestinal invasion of Salmonella in the central nervous system is unusual. We present the case of an afebrile 58-year-old male who presented with a headache and a progressive dull response for a week. He had a closed head injury approximately 1 week before this visit. A tentative diagnosis led to a subdural hematoma (SDH), and he underwent urgent burr hole surgery. Intraoperative findings showed a large amount of brown-yellow pus in the subdural space instead of the pathognomonic bloody serosanguinous or thick motor oil, which is typical of SDH. The intraoperative culture yielded Salmonella group D1. After initial brain surgery and 52 days of effective intravenous administration of a third-generation cephalosporin (Ceftriaxone 2000 mg per day), the patient recovered fully without neurological deficits. His consciousness and mentality remained normal without focal weakness of the limbs for over 5 years of follow-up. This is a unique case with an atypical initial presentation that leads to a final unexpected diagnosis. Ongoing treatment strategies include a combination of surgical drainage for disease confirmation and appropriate medical antibiotics.
ISSN:1178-6973
1178-6973
DOI:10.2147/IDR.S388101