IDCases · 2026
Diagnosis and management of subdural empyema with negative cultures: The value of magnetic resonance imaging and early surgical.
Клинический случайСтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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История · было → стало
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Nguyen Quoc Phuong, Doan Duy Thanh, Dinh Thi Thu Huong
Аннотация
BACKGROUND: Subdural empyema (SDE) is a neurosurgical emergency with 6-15% mortality. Culture-negative cases pose significant diagnostic and therapeutic challenges.
CASE PRESENTATION: A 51-year-old male with chronic alcohol abuse presented with high fever (39°C), severe headache, meningismus, and altered mental status (GCS 13). CSF analysis revealed protein 28 g/L (60-fold elevated), uncountable cells due to viscous fluid, and Gram-positive cocci. Initial non-contrast CT suggested chronic subdural hematoma, but surgical exploration revealed frontal subdural empyema with frank purulent discharge. All cultures (pus, CSF, blood, urine) were negative despite elevated inflammatory markers (CRP 303 mg/L, PCT 2.12 ng/mL, WBC 16.7 × 10⁹/L). Treatment with surgical drainage and combination antibiotics (meropenem with linezolid) achieved complete recovery after 24 days.
CONCLUSION: This case emphasizes the diagnostic challenges of distinguishing subdural hemorrhage from empyema on a CT scanner, the critical importance of early surgical intervention, and the necessity of broad-spectrum empirical antibiotics, with consideration of molecular diagnostics when cultures are negative.
CASE PRESENTATION: A 51-year-old male with chronic alcohol abuse presented with high fever (39°C), severe headache, meningismus, and altered mental status (GCS 13). CSF analysis revealed protein 28 g/L (60-fold elevated), uncountable cells due to viscous fluid, and Gram-positive cocci. Initial non-contrast CT suggested chronic subdural hematoma, but surgical exploration revealed frontal subdural empyema with frank purulent discharge. All cultures (pus, CSF, blood, urine) were negative despite elevated inflammatory markers (CRP 303 mg/L, PCT 2.12 ng/mL, WBC 16.7 × 10⁹/L). Treatment with surgical drainage and combination antibiotics (meropenem with linezolid) achieved complete recovery after 24 days.
CONCLUSION: This case emphasizes the diagnostic challenges of distinguishing subdural hemorrhage from empyema on a CT scanner, the critical importance of early surgical intervention, and the necessity of broad-spectrum empirical antibiotics, with consideration of molecular diagnostics when cultures are negative.