PDF(Pubmed)
Abstract：
We are reporting a very rare case of an invasive infection with Arcanobacterium haemolyticum and Fusobacterium necrophorum that resulted in meningitis, cerebral edema, and subdural empyema secondary to upper respiratory infection (URI) and sinusitis in an immunocompetent adolescent patient. Our patient is a 17-year-old male with no significant medical history who presented to his pediatrician with a fever for three days, was diagnosed with a viral URI, and instructed to continue symptomatic care. Seven days later, the patient developed a headache, left-sided weakness, and continued to spike fever. The patient presented to the Emergency Center due to altered mental status, worsening left-sided weakness, and difficulty speaking. Head computed tomography (CT) scan showed small right-sided fluid collection with right-to-left midline shift and marked opacification of paranasal sinuses with air-fluid levels in frontal sinuses. The patient underwent an emergent craniotomy that revealed subdural empyema under high pressure and was started on vancomycin, cefepime, metronidazole, and levetiracetam. Six hours after his craniotomy, the patient developed fixed dilatation of his right-side pupil and a head CT scan showed developing ischemic changes and increased in his midline shift which prompted to emergent right decompressive craniectomy. The following day of his surgery, magnetic resonance imaging of the brain showed large acute infarctions of the right hemisphere, edema, and subfalcine herniation. Two brain death exams - 12 hours apart - were performed in which criteria for brain death were met. The patient\'s subdural empyema culture grew Fusobacterium necrophorum and Arcanobacterium haemolyticum.
摘要：
我们正在报告一个非常罕见的病例，感染溶血性弧菌和坏死梭菌，导致脑膜炎，脑水肿,免疫功能正常的青少年患者继发于上呼吸道感染（URI）和鼻窦炎的硬膜下脓胸。我们的病人是一名17岁的男性，没有明显的病史，他因发烧三天向儿科医生就诊，被诊断出病毒URI，并指示继续对症治疗。七天后,病人出现头痛,左边的弱点，继续高烧。患者因精神状态改变而被送往急救中心，左侧弱点恶化，和说话困难。头部计算机断层扫描（CT）扫描显示右侧少量液体收集，中线从右到左移位，鼻旁窦明显混浊，额叶窦中的空气-液体水平。患者接受了紧急开颅手术，在高压下显示硬膜下积脓，并开始服用万古霉素，头孢吡肟,甲硝唑,和左乙拉西坦.他开颅手术六个小时后，患者右侧瞳孔出现固定扩张，头部CT扫描显示出现缺血性改变，中线移位增加，这促使紧急右侧去骨瓣减压术。他手术的第二天,大脑的磁共振成像显示了右半球的大面积急性梗塞，水肿,和亚恶性脑疝。进行了两次脑死亡检查-相隔12小时-符合脑死亡标准。患者的硬膜下脓胸培养物生长坏死梭杆菌和溶血性弧菌。
