Subgaleal abscess: An unusual presentation

Wiley, James F.; Sugarman, Jacqueline M.; Bell, Louis M.

doi:10.1016/s0196-0644(89)80021-6

Cited by 18 publications

(13 citation statements)

References 14 publications

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“…Chen et al [6] de- scribed a 1-month-old infant with an infected SGH from methicillin-resistant S. aureus thought to be caused by hematogenous spread from nearby skin pustules. Wiley et al [10] described a case of a 16-year-old male with an SGH infected with group A Streptococcus caused by minor head trauma thought to have seeded from skin wounds created by a concomitant varicella infection. Pollack et al [11] reported an infected SGH that presented 6 days after vacuum delivery with a polymicrobial flora.…”

Section: Discussionmentioning

confidence: 99%

“…In neonates and infants, even a small amount of blood loss can lead to hemodynamic instability due to their low total blood volume [5,7] . Infection associated with SGH is usually due to concomitant scalp laceration [8,9] ; however, there are rare reports of superimposed SGH infection without obvious overlying skin disruption [10,11] . In this article, we illustrate a case of secondarily infected SGH in an infant following closed head trauma without disruption of the skin and review the literature on SGH infection.…”

Section: Introductionmentioning

confidence: 99%

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Infected Subgaleal Hematoma Following Blunt Head Trauma in a Child: Case Report and Review of the Literature

et al. 2015

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Subgaleal hematoma (SGH), an uncommon but potentially dangerous complication, has been reported to occur with delivery in newborns, as well as in young patients following head trauma. Infection of a SGH is extremely rare, especially in cases where no disruption of the skin barrier occurs. We report a case of an infected SGH in an 8-month-old following closed skull fracture. The patient presented with scalp swelling 1 day after falling 3 feet. Initial evaluation found a nondisplaced skull fracture on computed tomography. She was discharged following an uneventful 23-hour observation. Three days later, she developed symptoms concerning for a viral upper respiratory tract infection and received symptomatic treatment. Nine days after injury, she returned with continued fevers, irritability, and significant increase in scalp swelling. Magnetic resonance imaging showed a subgaleal abscess with osteomyelitis. Needle aspiration revealed an infected hematoma with cultures positive for Streptococcus pneumoniae, treated with intravenous ampicillin. Purulent drainage from an enlarging necrotic needle aspiration site required subsequent surgical debridement of the subgaleal abscess with drain placement. She recovered well following surgery and intravenous antibiotics. Physicians should be aware that SGH carries a risk of serious morbidity and mortality. SGH can serve as a nidus for infection, typically from skin barrier breakdown or, as in this case, hematogenous spread. Early recognition, appropriate antibiotic therapy, and surgical debridement are critical in treating infected SGH.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Infected Subgaleal Hematoma Following Blunt Head Trauma in a Child: Case Report and Review of the Literature

et al. 2015

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“…Suppurative bacterial infections of the nervous system are extremely rare. Bacterial meningitis and subgaleal and brain abscesses have been observed after varicella among older children, [5][6][7] but only 3 pediatric case reports of VZV-associated GAS meningitis were published previously. [8][9][10] We found 2 additional cases in a series of invasive GAS disease cases among children with varicella reported by Vugia et al 11 In that report, the authors mentioned 2 children who died at home on day 6 and 4 of varicella and for whom GAS was recovered from postmortem CSF and brain cultures.…”

Section: Discussionmentioning

confidence: 99%

Group A Streptococcal Subdural Empyema as a Complication of Varicella

2005

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ABSTRACT. Group A ␤-hemolytic streptococcus and Staphylococcus aureus are the 2 most common pathogens implicated in secondary invasive bacterial disease after varicella. We describe a 3-month-old male infant from British Columbia, Canada, who presented on day 5 of varicella skin rash with fever, seizures, lethargy, and evidence of intracranial hypertension. A prominent subdural empyema was documented, and Streptococcus pyogenes was recovered from the subdural fluid. Central nervous system bacterial complications should be part of the differential diagnosis for infants and children with chickenpox who present with fever, lethargy, focal seizures, or similar neurologic findings. This case illustrates the importance of universal varicella vaccination to prevent associated bacterial complications of chickenpox. T he clinical course of varicella in childhood is usually benign and self-limited. However, secondary bacterial complications can occur in skin, soft tissues, and other sites, caused predominantly by group A streptococcus (GAS) and Staphylococcus aureus. 1 For varicella-associated, invasive, suppurative complications, the former is associated with increased morbidity and mortality rates among both immunocompetent and immunosuppressed children, and episodes can occur even without an obvious skin source of infection. Among children, GAS infections of the central nervous system (CNS) and peripheral nervous system after chickenpox are extremely rare. [2][3][4] We describe an infant who developed a GAS subdural empyema during varicella, which is, to our knowledge, an association not described previously. CASE REPORTA 3-month-old boy was admitted to a community hospital, on day 5 of a varicella skin rash, with fever and focal seizures. On day 1 of the rash, the patient developed decreased appetite and vomited twice; the following day, he began to exhibit a fever of 39°C. On day 4, he was examined at a primary care clinic, a diagnosis of acute otitis media (AOM) was made, and treatment with orally administered trimethoprim-sulfamethoxazole was initiated (the patient received a total of 2 doses). On day 5, the patient was described by his parents as being irritable and lethargic, and that night he developed right-sided focal seizures of the face, arm and leg, with subsequent ocular deviation. The seizures persisted, became generalized, and led to status epilepticus, which necessitated repeat doses of intravenously administered diazepam and phenytoin after admission to the local hospital. The body temperature was 37.8°C, a diffuse varicella skin rash with no evidence of secondary bacterial infection was described, and no AOM was observed. The patient underwent head computed tomography, which showed bilateral subdural fluid collections with left-sided predominance, with a compressed ventricular system and mild midline deviation. A clinical diagnosis of varicella encephalitis and subdural effusions was made, blood cultures were obtained, 1 dose of acyclovir was administered intravenously, and the patient was transferred...

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“…These children may present with streptococcal toxic shock syndrome,15 22 necrotising fasciitis,14 osteomyelitis,23 pyomyositis,24 gangrene,25 subgaleal abscess,26 arthritis,27 or meningitis28 associated with varicella. Christie et al examined the medical records of 60 children presenting to two centres in the United States with bacteraemia caused by group A streptococcus 29.…”

Section: Discussionmentioning

confidence: 99%