P1981 - Salmonella Thompson-Associated Subdural Empyema: Case Report and Review of the Literature

Monday, October 25, 2021

10:30 AM – 4:15 PM PT

Location: Shoreline Exhibit Hall

Has Audio

Presenting Author(s)

Mahum Nadeem, MD

University of Oklahoma Health Sciences Center
Oklahoma City, OK, United States

Mahum Nadeem, MD, Maham Hayat, MD, Gina Moon, MD, Amir Rumman, MD, FRCPC
University of Oklahoma Health Sciences Center, Oklahoma City, OK

Introduction: Salmonella, a gram-negative rod-shaped bacterium is a leading cause of diarrheal illness. Intracranial Infections are frequently reported in children as a complication of meningitis. Herein we report the first known case of adult intracranial salmonella infection, caused by Salmonella thompson, presenting as subdural empyema after a 5-day course of diarrheal illness.

Case Description/Methods: A 68-Year-old Caucasian female with history of atrial fibrillation on rivaroxaban and hypertension presented to the ER following a fall, and development of left-sided weakness. Review of systems was remarkable for a 5-day history of non-bloody watery diarrhea. Admission labs were significant for WBC 23 k/mm3, BUN 26 mg/dl, and creatinine 1.75 mg/dl. On physical examination patient was confused, had right periorbital bruising, and left visual hemineglect. Focal weakness was noted in the left lower extremity. Computed tomography scan of her head revealed a subdural collection along the right cerebral convexity, which was predominantly hypodense with scattered small areas of acute hyperdense blood products causing a 1cm leftward midline shift. An emergent right craniotomy was performed for evacuation of subdural hematoma. This showed cloudy fluid with fibrous cloudy fibers on the brain surface and undersurface of dura concerning for empyema. Brain tissue cultures grew Salmonella thompson, sensitive to ceftriaxone. The patient completed 6 weeks of intravenous ceftriaxone and on follow up had complete recovery of her neurological symptoms.

Discussion: The literature contains around 80 described cases of focal intracranial infection by Salmonella, including cerebral abscesses and subdural and epidural empyema. Salmonella thompson is a rare Salmonella species and has been reported to spread through fecal-oral transmission resulting in diarrheal outbreaks, mostly associated with chicken and fish products. To our knowledge this is the first reported adult case of Salmonella thompson associated intracranial infection. Early diagnosis, prompt surgical evacuation of the subdural collection, and prolonged antibiotic therapy are essential to achieve a good outcome.

Year	Author	Age	Sex	*Species*	Co-morbidities	Location	Clinical features	Treatment (treated surgically)
1997	Aliaga	37	Male	Salmonella enteritidis	HIV, Frontal osteomyelitis	Frontal lobe subdural and epidural	Headache, fever	Ciprofloxacin Recovered
1983	Boles	55	Male	Salmonella sandiego	Alcoholic	Post- traumatic hematoma infection	-	-
1995	Mussini	29	Male	Group B salmonella, serotype Copenhagen	HIV	Right parietal subdural empyema	Headache, left hemianopsia	Ciprofloxacin Recovered
1995	Parkers	63	Female	Salmonella Dublin	HIV	Left frontoparietal subdural collection	Weakness diarrhea, right facial weakness, dysphasia, thrush	Cefotaxime Recovered
1995	Dill	55	Male	Typhimurium	Post trauma	Infra-orbital trauma	-	-
1998	M kan	64	Male	Salmonella enteritidis	MDS	Right chronic subdural hematoma	Deterioration of consciousness	-
2000	Chandy	66	Male	Salmonella D	DM	Left-fronto parietal region	headache, seizures, right sided weakness	Cipro- recovered
2002	Mahapatra (2 cases)	56 & 25	male	Salmonella typhi + Group D	-	Subdural empyema	Altered consciousness, fever, focal deficits	-
2010	Hayakawa	65	Male	Salmonella enterica serovar Typhimurium	Alcoholic, gastrectomy	left chronic subdural hematoma	Headache, fever, weakness	Ceftriaxone- Recovered

Table: Literature review of previous cases of salmonella and subdural empyema

Disclosures:

Mahum Nadeem indicated no relevant financial relationships.

Maham Hayat indicated no relevant financial relationships.

Gina Moon indicated no relevant financial relationships.

Amir Rumman indicated no relevant financial relationships.

Mahum Nadeem, MD, Maham Hayat, MD, Gina Moon, MD, Amir Rumman, MD, FRCPC. P1981 - Salmonella Thompson-Associated Subdural Empyema: Case Report and Review of the Literature, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.