An unusual case of meningococcal meningitis complicated with subdural empyema in a 3 month old infant: a case report

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.

Figure 1

MRI HEAD (axial) without contrast. Meningitis related bifrontal/bitemporal subdural empyema. Notice the pronounced thickening up to 1.2 cm in the left side.