Abstract
Subdural empyema is an unusual complication of meningococcal meningitis, and in acute cases can be rapidly fatal. We present a case of an 8 week old infant who presented with atypical Neisseria meningitis with bifrontal subdural empyema formation. Through the utilisation of modern polymerise chain reaction tests on cerebrospinal fluid samples, we were able to confirm the diagnosis and institute appropriate treatment. Early surgical intervention and appropriate intravenous antibiotics meant that the patient fully recovered. In summary, early treatment of meningitis without adequate microbiological investigations can complicate later diagnosis of subdural empyema. Early suspicion of empyema should be considered when patient fails to improve after 48 hrs, seizures are a late sign and gives a poorer prognosis. Computed tomography scanning is still the modality of choice although in this case, magnetic resonance imaging had its benefits. Polymerase chain reaction of cerebrospinal fluid testing may also provide an important confirmatory test in future.
Highlights
Neisseria meningitidis is a heterotrophic Gram-negative aerobic diplococcus with a polysaccharide capsule
Subdural empyema is an unusual complication of meningococcal meningitis, and in acute cases can be rapidly fatal
We present a case of an 8 week old infant who presented with atypical Neisseria meningitis with bifrontal subdural empyema formation
Summary
Neisseria meningitidis is a heterotrophic Gram-negative aerobic diplococcus with a polysaccharide capsule. A literature search through Pubmed found only 9 cases of Neisseria meningitis with subdural empyema as a complication. Lumbar puncture (LP) was performed after antibiotics; cerebrospinal fluid (CSF) was blood-stained and showed white cells of 30, red cells of 40,500 with 100% lymphocytosis. Gram stain was negative; CSF protein was 4.8 and glucose 0.5. Despite 2 days of treatment the patient continued to spike fevers, clinical symptoms improved. She developed a non-productive cough, with increased respiratory effort. Both blood and CSF cultures were negative, and CRP had risen to 388. CSF polymerase chain reaction (PCR) result from the reference laboratory showed a Neisseria meningitidis, confirming the diagnosis. Sputum sample from the reference lab, following this showed Respiratory Syncytial Virus
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