感染性硬膜下血腫の1乳児例

抄録

A 2-month-old boy presented with infected subdural hemorrhage manifesting as sustained fever and seizures. The boy had been well without contributory medical history. Physical examination found no neurological impairment with intact superficial appearance. The parents reported no recent trauma or shaking injury. Blood examination was normal except for white blood cell count of 19200/µl and C-reactive protein level of 6.7 mg/dl. Bacterial culture of nasal swab, urine, stool, and venous blood samples was negative. Cerebrospinal fluid examination showed normal findings. Cranial computed tomo­graphy revealed an expansive subdural fluid collection in the right frontotemporal region. Magnetic resonance imaging showed the lesion as heterogenous intensity on T1- and hyperintensity on T2-weighted images with intense enhancement of the outer membrane. The patient underwent burr-hole drainage, which identified an encapsulated subdural hematoma, intermingled with pus material. Culture of the pus identified Escherichia coli (E. coli). The patient received antibiotic therapy for 8 weeks that resulted in complete resolution of the infection. We as­sumed that preexisting subdural hematoma arising after un­recognized minor head trauma was hematogenously infected by E. coli. Infected subdural hematoma should be assumed as differential diagnosis in infants presenting with subdural hemor­rhage and bacteremia.