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Superimposed propionibacterium acnes subdural empyema in a patient with chronic subdural hematoma

Jong Hun Kim1, Chul-Hee Lee, Soo Hyun Hwang

  • 1Department of Neurosurgery, Gyeongsang National University School of Medicine, Jinju, Korea.

Journal of Korean Neurosurgical Society
|February 27, 2009
PubMed

Insights

This case study highlights a rare subdural empyema in a macrocephalic patient, likely stemming from a chronic subdural hematoma. Long-term antibiotic treatment was required for this Propionibacterium acnes infection.

Area of Science:

  • Neurology
  • Infectious Diseases
  • Neurosurgery

Background:

  • Subdural empyema is a rare but serious intracranial infection.
  • Macrocephaly can present diagnostic challenges in neurological cases.
  • Chronic subdural hematomas are collections of blood that can predispose to infection.

Observation:

  • A 23-year-old male with macrocephaly presented with headache and fever post-head injury.
  • Initial imaging suggested an epidural abscess, but surgery revealed a subdural empyema.
  • Histology indicated a coexisting chronic subdural hematoma capsule.

Findings:

  • Propionibacterium acnes was identified as the causative agent of the subdural empyema.
  • Treatment involved eight weeks of intravenous antibiotics with C-reactive protein monitoring.
  • Follow-up CT showed residual subdural lesion, though the patient experienced minimal symptoms.

Implications:

  • Subdural empyema can arise secondary to chronic subdural hematoma, particularly after head trauma.
  • Propionibacterium acnes subdural empyema necessitates prolonged antibiotic therapy.
  • This case underscores the importance of considering subdural empyema in patients with pre-existing subdural collections and neurological symptoms.
Keywords:
C-reactive proteinChronic subdural hematomaPropionibacterium acnesSubdural empyema

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