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Combined Near-infrared Fluorescent Imaging and Micro-computed Tomography for Directly Visualizing Cerebral Thromboemboli

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Streptococcus pyogenes subdural empyema not detected by computed tomography.

Shelton Viola¹, Gregory Montoya, John Arnold

¹Division of Infectious Diseases, Naval Medical Center, San Diego, CA 92134, USA.

International Journal of Infectious Diseases : IJID : Official Publication of the International Society for Infectious Diseases

|July 19, 2008

Summary

A previously healthy child developed Streptococcus pyogenes bacteremia, leading to a subdural empyema. This case highlights rare intracranial infections without meningitis, emphasizing advanced imaging for diagnosis.

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Area of Science:

Pediatric Neurology
Infectious Diseases
Neuroradiology

Background:

Streptococcus pyogenes (Group A Streptococcus) can cause serious infections.
Intracranial infections are rare but severe complications of bacterial infections.

Observation:

A 5-year-old boy presented with fever and seizures.
Blood cultures positive for Streptococcus pyogenes.
Initial head CT was normal, but MRI revealed subdural empyema.

Findings:

The patient had Streptococcus pyogenes subdural empyema without adjacent infection or meningitis.
This presentation is atypical for S. pyogenes intracranial infections.
Computed tomography (CT) sensitivity for bacterial intracranial infections is discussed.

Implications:

Subdural empyema should be considered in febrile children with neurological symptoms, even with normal initial CT scans.
Magnetic resonance imaging (MRI) is crucial for diagnosing intracranial complications.
This case expands the understanding of Streptococcus pyogenes neuroinvasive potential.