Background: Subdural empyema (SE) is a rare but life-threatening intracranial complication of Bacterial meningitis, occurring in approximately 1–2% of cases in infants. Prompt diagnosis and neurosurgical intervention are essential to reduce morbidity and mortality. Case Presentation: A 4-month-old immunocompetent female infant presented with high fever and lethargy. Blood, cerebrospinal fluid, and urine cultures confirmed infection with E. coli K1+. Despite treatment with a third-generation cephalosporin, persistent fever prompted neuroimaging. Brain CT and contrast-enhanced MRI revealed large bilateral subdural empyemas with associated meningitic changes. The patient underwent bilateral frontoparietal craniotomies with drainage of the empyemas and removal of pseudomembranes. Postoperatively, she experienced two focal seizures, which were successfully managed with levetiracetam. She completed a three-week course of cefotaxime and meropenem and was discharged on antiepileptic therapy. Discussion: Molecular analysis of the purulent specimen confirmed E. coli as the causative organism. Follow-up MRI performed six months after surgery demonstrated complete resolution of the empyemas, allowing discontinuation of antiepileptic therapy. At three years of follow-up, the child exhibited normal neurological development without residual deficits, highlighting the effectiveness of early diagnosis, aggressive antimicrobial therapy, and timely neurosurgical management. Conclusion: Bilateral subdural empyema is an uncommon but serious complication of E. coli K1+ bacterial meningitis in infants. Early recognition through advanced neuroimaging, prompt surgical drainage, and appropriate antimicrobial therapy can result in excellent long-term neurological outcomes.
Keywords: subdural empyema, E.coli, meningitis, infant
Subdural empyema (SE) denotes the collection of purulent material in the subdural space. In infants and neonates, SE is most frequently a complication from bacterial meningitis. Although it is extremely rare, occurring in 1-2% of all cases of bacterial meningitis, at most, morbidity and mortality may be high [1,2].
A four-month immunocompetent female infant, presented at the ER with high fever and lethargy, starting fourteen hours prior to admission. She was born full term and hospitalized in NICU with a seven-day antibiotic course for suspected sepsis. A full bacterial workup was performed (blood culture, lumbar puncture & urine culture) which came positive for E Coli K1+ with AST profile resistant only at quinolones. A third generation cephalosporin was started. Due to persistent fever, an emergency brain CT scan without contrast was performed and it revealed hypodense extra-axial collections over both frontotemporoparietal convexifant: An Unusual Complication of E.coli K1+ Bacterial Meningitis. Arch Clin Case Rep, 5(1): 04-06.
ties. A subsequent brain MRI study (1.5-T system) with contrast was performed. It showed large bilateral subdural effusions with mixed signal intensity, restricted diffusion and rim enhancement compatible with empyemas, meningitic changes and contrast enhancement of pseudo membranes inside the empyemas (Figure 1A-D). Bilateral frontoparietal cranotomies were performed and drainage of subdural effusions as well as removal of pseudo membranes was achieved with favourable outcome. RT-PCR of the purulent specimen identified E coli as the causative organism with pleocytosis (260 leucocyte/μL, 75% neutrophils) and high protein levels (1970mg%). Forty-eight hours post-operative she had two prolonged episodes of focal seizures and levetiracetam was then added. She received a total of three weeks of antibiotics (cefotaxime and meropenem) and was discharged with antiepileptic therapy. Six months post-operative brain MRI was normal, and antiepileptic therapy was discontinued (Figure 2A-D). Currently, she is three years old with no neurological deficits.
Subdural empyema due to meningitis in infants is unique with respect to the pathophysiology, presentation, and treatment of SD. Early detection and neurosurgical involvement and evaluation are imperative to achieve timely diagnoses and to guide management fant: An Unusual Complication of E.coli K1+ Bacterial Meningitis. Arch Clin Case Rep, 5(1): 04-06. in these critically ill children [1,3].
This case report was produced in accordance with institutional policies; the patient’s parents gave written, informed consent for publication of this case report and any accompanying images. The paper is exempt from ethical committee approval, since this is a retrospective presentation of the case report
The authors have no conflicts of interest to declare.
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