Chronic Subdural Hematoma Infected by Propionibacterium Acnes: A Case Report

Abstract

We present a very rare case of a patient with an infected subdural hematoma due to Propionibacterium acnes. A 63-year-old male complained of dizziness and was admitted to our hospital. He had a history of left chronic subdural hematoma due to a traffic accident, which had been conservatively treated. Physical, neurological and laboratory examinations revealed no definite abnormality. Plain CT scan demonstrated a hypodense crescentic fluid collection over the surface of the left cerebral hemisphere. The patient was diagnosed with chronic subdural hematoma and underwent burr hole surgery three times and selective embolization of the middle meningeal artery, but the lesion easily recurred. Repeated culture examinations of white sedimentation detected P. acnes. Therefore, he underwent craniotomy surgery followed by intravenous administration of antibiotics. The infected subdural hematoma was covered with a thick, yellowish outer membrane, and the large volume of pus and hematoma was removed. However, the lesion recurred again and a low-density area developed in the left frontal lobe. Craniotomy surgery was performed a second time, and two Penrose drainages were put in both the epidural and subdural spaces. Subsequently, the lesions completely resolved and he was discharged without any neurological deficits. Infected subdural hematoma may be refractory to burr hole surgery or craniotomy alone, in which case aggressive treatment with craniotomy and continuous drainage should be indicated before the brain parenchyma suffers irreversible damage.

Subdural empyema complicated after trepanation and drainage of chronic subdural hematoma

“…[2,8,9] The most common infectious pathogen is Streptococcus milleri group, which is followed by other pathogenic bacteria, including b-hemolytic Streptococcus, Staphylococcus aureus, Haemophilus influenzae, Streptococcus mutans, and Pseudomonas. Escherichia coli, [15] Propionibacterium acnes, [16] Campylobacter fetus [17] and Klebsiella, [9,18] which are more rarely observed pathogens. Overall, 20% to 30% of cases of subdural empyema are not caused by infection with a single bacteria.…”

“…Overall, 20% to 30% of cases of subdural empyema are not caused by infection with a single bacteria. [8,9,15,16,17,18] In this case, the patient was infected with Klebsiella, a gram-negative bacillus that generally occurs in immunocompromised hosts. [9] This patient had a 25-year history of diabetes, which is a high risk factor for infection.…”

Efficacy of Middle Meningeal Artery Embolization for Organized Chronic Subdural Hematoma

“…Infection of OCSDH is rare, but once it occurs, it is difficult to cure by administration of antibiotics alone and craniotomy is necessary in many cases. 21,22,23) In Case 9 suspected as infectious subdural hematoma, MMA embolization caused reduction of blood flow to the hematoma capsule, and may decrease effect of antibiotics to the hematoma. Thus, if there is any suspect that the lesion is infectious subdural hematoma, MMA embolization should be strictly avoided.…”

Propionibacterium acnes Infection after Craniotomy in a Young Adult with Subdural Hematoma

“…Furthermore, postcraniotomy infection caused by P. acnes is relatively uncommon, but when it occurs, it can be associated with significant complications and can become life-threatening [4]. Only few cases have been reported in the literature [5]. In this case report, we present a rare case of craniotomy with subdural hematoma (SDH) evacuation complicated by subdural P. acnes infection in a young male patient.…”