An adult with a subdural abscess due to Salmonella Thompson

Abstract

  Intracranial infections caused by Salmonella spp. are not uncommon in pediatric patients, among whom Salmonella typhi (S. typhi) is the predominant pathogen. We report the rare case of an adult intracranial infection caused by Salmonella Thompson (S. Thompson). The patient was a 70‒year‒old Japanese man who was scheduled to be hospitalized for the evaluation of possible malignant lymphoma and presented with fever, headache, and altered consciousness. Brain computed tomography (CT) revealed a subdural lesion with midline shift. He underwent urgent burr hole drainage with a preoperative diagnosis of subdural empyema. When the dural incision was performed, white pus was observed and evacuated, confirming the diagnosis of a subdural empyema. A bacterial culture of the pus identified S. Thompson as the pathogen. The patient’s symptoms gradually improved with a 6‒week ceftriaxone regimen, and follow‒up brain CT revealed resolution of the empyema. Whole‒body CT for a systemic evaluation revealed intra‒abdominal lymphadenopathy. The biopsy of the lymph nodes led to a diagnosis of mantle cell lymphoma. The patient was transferred to the hematology department for chemotherapy and achieved remission of the lymphoma. Although the route of infection remained unidentified, he was subsequently discharged home. This appears to be the first reported case of an adult subdural empyema caused by S. Thompson. Clinicians should be aware that Salmonella spp. can be the cause of intracranial infections in patients with immunosuppressive conditions or latent systemic diseases.