An unusual presentation of subdural empyema caused by Porphyromonas gingivalis

Abstract

Subdural empyema is an uncommon clinical entity. The first case of Porphyromonas gingivalis subdural empyema is reported. We report a case of 34-year-old male who presented with subdural empyema and sinusitis. Through the utilization of polymerase chain reaction (PCR) tests on subdural pus, we were able to confirm the diagnosis and institute appropriate treatment. Early surgical intervention and intravenous antibiotics meant that the patient recovered fully. Infections caused by P. gingivalis should be considered in differential diagnoses of central nervous system (CNS) abscesses or subdural empyema especially in patients with precedent periodontal diseases and sinusitis.

Keywords: Porphyromonas gingivalis; periodontal disease; subdural empyema.

Figure 1

Subdural empyema at right frontal convexity and along right side falx cerebri, about 0.6 cm in maximal thickness at right frontal lobe. Minimal brain swelling and effacement of adjacent cortical sulci and right lateral ventricle with shifting of midline structures to the left about 0.2 cm. Opacification at both frontal sinuses, ethmoid, and left maxillary sinuses

Figure 2

Subdural collection over right hemispheric convexity and right interhemispheric fissure, most pronounced collection of 0.7 cm thickness at right frontal convexity near right frontal sinus. Mass effect of right subdural collection causing subfalcial brain herniation to the left side about 0.8 cm