Metastatic Epidural Bacterial Abscess in a 4-Year-Old Boy

Abstract

A4-YEAR-OLD BOY with communityacquired pneumonia unresponsive to outpatient antibiotics was admitted to the hospital for intravenous treatment. Chest computed tomography revealed left lower lobe pulmonary empyema (Figure 1), which led to the placement of a chest tube. After 1 week of intravenous antibiotics, the chest tube was removed and the patient was to be discharged home. Unexpectedly, the patient’s clinical condition deteriorated. He became encephalopathic and had evidence of tonic eye deviation to the right. While undergoing an emergency computed tomographic scan of the head, the patient had a generalized tonic-clonic seizure. Head computed tomography revealed osteomyelitis of the left anterior, medial, and inferior frontal bone as well as leftanterior,inferior,andmedialepidural fluid collection suggestive of an epidural abscess. Brain magnetic resonance imaging with and withoutcontrastconfirmedthefindings (Figure 2). The neurosurgeonperformedanemergencyhemicraniotomyandabscessevacuation; the surgical procedure was not associated with complications. Six monthslater,atafollow-upappointment, the patient had no evidence of neurological deficit.