title: Streptococcus pluranimalium: A novel human pathogen?
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Emergency Medicine, Rashid Hospital Trauma Center, Dubai, United Arab Emirates. Electronic address: lasanthi@gmail.com.
authors.forename: Lasanthi
authors.initials: L
authors.lastname: Aryasinghe
authors.affiliation: Department of Emergency Medicine, Rashid Hospital Trauma Center, Dubai, United Arab Emirates.
authors.forename: Saweera
authors.initials: S
authors.lastname: Sabbar
authors.affiliation: Department of Emergency Medicine, Rashid Hospital Trauma Center, Dubai, United Arab Emirates.
authors.forename: Yasmin
authors.initials: Y
authors.lastname: Kazim
authors.affiliation: Department of Neurosurgery, Rashid Hospital Trauma Center, Dubai, United Arab Emirates.
authors.forename: Liaqat Mahmood
authors.initials: LM
authors.lastname: Awan
authors.affiliation: Department of Emergency Medicine, Rashid Hospital Trauma Center, Dubai, United Arab Emirates.
authors.forename: Hammad Khan Nadir
authors.initials: HK
authors.lastname: Khan
keywords: Complicated sinusitis; Intracranial abscess; Streptococcus pluranimalium; Subclinical sinusitis; Subdural empyema