Streptococcus pluranimalium: A novel human pathogen?

INTRODUCTION: We present the first case of a subdural empyema caused by Streptococcus pluranimalium, in a healthy adolescent male as a possible complication of subclinical frontal sinusitis. Clinical features, diagnostic approach and management of subdural empyema are discussed. PRESENTATION OF CASE: A 17-year-old male with a 2 day history of headache and nausea was referred to our Emergency Department (ED) as a case of possible meningitis. He was afebrile, lethargic and drowsy with significant neck stiffness on examination. Computerized tomography (CT) revealed a large frontotemporoparietal subdural fluid collection with significant midline shift. Subsequent contrast-enhanced CT established the presence of intracranial empyema; the patient underwent immediate burr-hole evacuation of the pus and received 7 weeks of intravenous antibiotics, recovering with no residual neurological deficit. DISCUSSION: The diagnosis of subdural empyema as a complication of asymptomatic sinusitis in an immunocompetent patient with no history of fever or upper respiratory symptoms was unanticipated. Furthermore, the organism Streptococcus pluranimalium that was cultured from the pus has only been documented twice previously in medical literature to cause infection in humans, as it is primarily a pathogen responsible for infection in bovine and avian species. CONCLUSION: Subdural empyema represents a neurosurgical emergency and if left untreated is invariably fatal. Rapid diagnosis, surgical intervention and intensive antibiotic therapy improve both morbidity and mortality.