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Background: Infections of central nervous system after spinal anesthesia nowadays are a rarity; however, their presence might be of concern. Case Description: We report the case of lateral ventricular empyema treated unsuccessfully with parenteral antibiotic therapy, with the clinical signs of a persisting meningitis. After several lumbar taps suggesting an infection, Pseudomonas aeruginosa was isolated and a brain magnetic resonance imaging find out the collection in the left horn of the lateral ventricle. An intrathecal/intraventricular antibiotic therapy with colistin proved highly effective combined with an extra ventricular drainage to deal with the hydrocephaly. Conclusion: Clinicians should take into account even uncommon infectious agents while facing the picture of a meningitis otherwise nonresponsive to empiric or standard therapy.

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The differential diagnosis of low back pain is long and rarities are under-diagnosed, with problems generally simplified as lumbar vertebral spondylosis or rheumatic conditions. Abscesses of piriform muscle are a particularity worth of evaluating when specific MRI changes are detected, and the condition might be underdiagnosed leading to delays in the treatment. We describe the case of an 18-year-old male with pyomyositis of left piriform muscle, complicated with iliac and femoral vein thrombosis, that responded well to combined antibiotherapy, anticoagulants and drainage.

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