Neslihan Mete Atasever, Elif Dede, Ali Genco Gençay, Demet Demirkol, Tuğrul Cem Unal, İlyas Doğan, Levent Aydemir, Ayper Somer
Çocuk Dergisi - 2025;25(3):176-179
Abstract Closed head trauma is a rare cause of subdural empyema (SDE). It is often seen as a complication of paranasal sinusitis, mastoiditis, or otitis in older children. A 15-year-old male patient presented with complaints of headache, runny nose, and forehead fullness. Sinusitis was diagnosed. Treatment of sinusitis showed no benefit, but symptoms were observed to get progressively worse. MRI showed empyema in the subdural area on the left side of the interhemispheric fissure and extending to the left cerebral hemisphere frontoparietal subdural area, measuring 5.5 mm in its thickest part. The neurosurgeon evacuated the left interhemispheric SDE using the intraoperative ultrasound-guided single burr-hole technique. The left frontal empyema was also evacuated with a single burr-hole in the same session. No pathogens were grown in the purulent culture samples taken from the patient's lesion during the operation. Hyper sensitivity reaction to beta-lactam drugs was considered due to widespread maculopapular rash (>50% of body surface area), eosinophilia (10.2%), and liver enzyme elevation (ALT: 126 U/L, AST: 62 U/L) all over the body in the 3rd week of antibiotic therapy. Antiepileptics and antibiotics were discontinued. Methylprednisolone and cetirizine treatments were initiated. The patient's laboratory parameters improved within a week, and the steroid dose was tapered off, and his treatment was continued with ciprofloxacin. Poly saccharide pneumococcal and conjugated meningococcal vaccines were administered to the patient.
