Subdural empyema caused by Morganella morganii

Abstract

Background: Morganella morganii is a species of Gram-negative enteric rod found in normal human gut flora. Pathologically, this most often presents as urinary tract infections, wound infections, and bacteremia. It is highly uncommon for M. morganii to be implicated in a central nervous system infection, with only 12 reported cases of parenchymal abscesses or meningitis.

Case description: A previously healthy 13-month-old female presented with fever of unknown origin and had a witnessed seizure during evaluation. A large left subdural fluid collection was identified, and the patient underwent emergent burr hole drainage and subdural drain placement. Cultures demonstrated M. morganii empyema, and she subsequently completed a course of directed antibiotics. Six months following surgery, she has no further clinical or radiographic evidence of infection, seizures, or neurological sequelae.

Conclusion: We describe the first reported case of isolated subdural empyema caused by M. morganii. The child was successfully treated with the evacuation of the empyema and direct antibiotics with no lasting neurological injury.

Keywords: Infection; Morganella morganii; Pediatric neurosurgery; Subdural empyema.

Figure 1:

Preoperative MRI with coronal T1 postcontrast (a) and axial diffusion-weighted images (b) showing a large left subdural fluid collection concerning for hematoma with superimposed empyema and associated mass effect.

Figure 2:

Postoperative MRI with interval evacuation of the infected fluid collection and resolved mass effect.