Subdural empyema: an unusual complication of pediatric pyelonephritis

Abstract

We present a case involving a 6-month-old female patient who was admitted to the hospital due to symptoms of fever and difficulty with feeding. The patient’s medical history is significant, as she had previously experienced a septicemia episode originating from a urinary infection, which was accompanied by multifocal bilateral pyelonephritis and bacteremia one month earlier. While hospitalized, the patient suffered from a febrile status epilepticus, prompting investigations into potential involvement of the central nervous system. These investigations revealed the presence of a left subdural empyema, as seen on magnetic resonance  maging. This case highlights an uncommon complication of pyelonephritis and bacteremia, where the involvement of the central nervous system carries a significant risk of morbidity and mortality. Despite negative results from blood and cerebrospinal fluid tests for infection, computed axial tomography and magnetic resonance imaging of the brain are crucial in assessing the patient’s condition. The initial treatment approach for this condition involves medical management with neurological observation and antibiotic therapy, with surgical intervention considered as an alternative option.