Treatment of a subdural empyema complicated by intracerebral abscess due to Brucella infection

A 55-year-old male presented with fever, stupor, aphasia, and left hemiparesis. A history of head trauma 3 months before was also reported. Cranial magnetic resonance imaging revealed slight contrast enhancement of lesions under the right frontal skull plate and right frontal lobe. Because of deterioration in nutritional status and intracranial hypertension, the patient was prepared for burr hole surgery. A subdural empyema (SDE) recurred after simple drainage. After detection of Brucella species in SDE, craniotomy combined with antibiotic treatment was undertaken. The patient received antibiotic therapy for 6 months (two doses of 2 g ceftriaxone, two doses of 100 mg doxycycline, and 700 mg rifapentine for 6 months) that resulted in complete cure of the infection. Thus, it was speculated that the preexisting subdural hematoma was formed after head trauma, which was followed by a hematogenous infection caused by Brucella species.

一名55岁男性因发热、昏睡、失语及左侧偏瘫就诊，既往有3个月前头部外伤史。颅脑磁共振成像（cranial magnetic resonance imaging）显示右侧额骨板下病灶及右侧额叶可见轻度强化。因患者营养状况恶化并出现颅内高压，遂准备行颅骨钻孔手术。但单纯引流术后硬膜下积脓症（subdural empyema，SDE）复发。在硬膜下积脓症标本中检出布鲁氏菌属后，予开颅手术联合抗生素治疗。患者接受为期6个月的抗生素治疗：头孢曲松2g、每日2次，多西环素100mg、每日2次，利福喷汀700mg，持续6个月，最终感染完全治愈。据此推测，患者既往头部外伤后形成硬膜下血肿，后续继发布鲁氏菌属经血行传播引发的感染。