Pediatr Infect Vaccine.  2019 Aug;26(2):112-117. 10.14776/piv.2019.26.e13.

Epidural Abscess Caused by Eikenella corrodens in a Previously Healthy Child

Affiliations
  • 1Department of Pediatrics, Seoul National University Children's Hospital, Seoul, the Republic of Korea. eunchoi@snu.ac.kr
  • 2Department of Pediatrics, Seoul National University College of Medicine, Seoul, the Republic of Korea.
  • 3Department of Otorhinolaryngology, Seoul National University Hospital, Seoul, the Republic of Korea.
  • 4Department of Pediatrics, National Medical Center, Seoul, the Republic of Korea.

Abstract

Eikenella corrodens rarely causes invasive head and neck infections in immunocompetent children. We report a case of epidural abscess caused by E. corrodens in a previously healthy 13-year-old boy who presented with fever, headache, and vomiting. On physical examination upon admission, there was no neck stiffness, but discharge from the right ear was observed. Brain magnetic resonance imaging (MRI) revealed approximately 4.5-cm-sized epidural empyema on the right temporal lobe as well as bilateral ethmoid and sphenoid sinusitis, right mastoiditis, and right otitis media. During treatment with vancomycin and cefotaxime, purulent ear discharge aggravated, and on follow-up brain MRI, the empyema size increased to 5.6×3.4 cm with interval development of an abscess at the right sphenoid sinus. Burr hole trephination was performed, and foul-smelling pus was aspirated from the epidural abscess near the right temporal lobe. Pus culture yielded E. corrodens. Endoscopic sphenoidotomy was also performed with massive pus drainage, and the same organism was grown. The patient was treated with intravenous cefotaxime for 3 weeks and recovered well with no other complications. Therefore, E. corrodens can cause serious complications in children with untreated sinusitis.

Keyword

Epidural abscess; Sinusitis; Eikenella corrodens

MeSH Terms

Abscess
Adolescent
Brain
Cefotaxime
Child*
Drainage
Ear
Eikenella corrodens*
Eikenella*
Empyema
Epidural Abscess*
Fever
Follow-Up Studies
Head
Headache
Humans
Magnetic Resonance Imaging
Male
Mastoid
Mastoiditis
Neck
Otitis Media
Physical Examination
Sinusitis
Sphenoid Sinus
Sphenoid Sinusitis
Suppuration
Temporal Lobe
Trephining
Vancomycin
Vomiting
Cefotaxime
Vancomycin

Figure

  • Fig. 1 Brain T2 weighted image show 4.5×3.5 cm sized epidural empyema with air-fluid level in the right temporal lobe (white arrow) as well as bilateral ethmoid (black arrow), sphenoid sinusitis (arrow head), and mastoiditis (asterisk) (A), empyema size increase to 5.6×3.4 cm (white arrow) with interval development of an abscess at the right sphenoid sinus (arrow head) (B). Post-operative brain computed tomography showed near-complete removal of epidural abscess and fluid accumulated in the sphenoid sinus (C).

  • Fig. 2 Endoscopic view of the right sphenoid sinus. During endoscopic sinus surgery, pus gushed out from the sphenoid sinus ostium (A). Endoscopic images show the remaining pus on the floor of the sphenoid sinus (B) and the sphenoid sinus after vigorous irrigation (C).


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