Infantile Chronic Subdural Hematoma Infected by Escherichia Coli -Case Report-

Abstract

A 6-month-old boy presented with a rare case of infected subdural hemorrhage manifesting as sustained fever and focal seizure. The boy had been well without contributory medical history. Physical examination found no neurological impairment with intact superficial appearance and soft fontanels. The parents denied recent head trauma or shaking injury. Blood examination was normal except for white blood cell count of 19200/microl and C-reactive protein level of 6.7 mg/dl. Bacterial culture of nasal swab, urine, stool, and venous blood samples was negative. Cerebrospinal fluid examination showed normal findings. Cranial computed tomography revealed an expansive subdural fluid collection in the right frontotemporal region. Magnetic resonance imaging showed the lesion as hypointense on T1- and hyperintense on T2-weighted images with intense enhancement of the outer membrane. The patient underwent burr-hole drainage, which identified the subdural hematoma encapsulated in a thick outer membrane and intermingled with pus material. Culture of the pus identified Escherichia coli. The patient received antibiotic therapy for 8 weeks that resulted in complete resolution of the infection. We assumed that preexisting subdural hematoma formed after minor head trauma was followed by hematogenous infection by E. coli. Infected subdural hematoma is possible in infants presenting with subdural hemorrhage with clinical symptoms of bacteremia.