title: Streptococcal pharyngitis: an uncommon cause of subdural empyema.
abstract: A 7-year-old girl with an unremarkable medical history presented to a local paediatric emergency department with a 7-day history of fever, sore throat and vomiting, and a 1-day history of rash. She was admitted to the hospital, with presumed Kawasaki disease. A few hours after admission, the patient had sudden onset of two witnessed tonic-clonic seizures and subsequent decreased mental status. She was transferred to the paediatric intensive care unit and started on broad-spectrum antibiotics. On hospital day 2, cerebral spinal fluid cultures and blood cultures grew Streptococcus pyogenes, and repeat physical examination was consistent with acute streptococcal pharyngitis. On hospital day 3, the patient developed left-sided hemiparesis and had another witnessed seizure. A CT scan was obtained and revealed a subdural abscess. She was transferred to a tertiary care centre and underwent craniotomy with evacuation of her subdural abscess. Surgical cultures eventually grew S. pyogenes.
authors.affiliation: Department of Family Medicine, University of North Carolina Chapel Hill, Greensboro, North Carolina, USA.
authors.forename: Jeffrey Howard
authors.initials: JH
authors.lastname: Walden
authors.affiliation: Cone Health Family Medicine Residency, Greensboro, North Carolina, USA.
authors.forename: Bryan
authors.initials: B
authors.lastname: Hess
authors.affiliation: Cone Health Family Medicine Residency, Greensboro, North Carolina, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Rigby
mesh_terms: D002648:Child; D013354:Empyema, Subdural / Q000382:microbiology*; D005260:Female; D006801:Humans; D010291:Paresis / Q000382:microbiology; D010612:Pharyngitis / Q000150:complications* / Q000382:microbiology; D012640:Seizures / Q000382:microbiology; D013290:Streptococcal Infections / Q000150:complications* / Q000382:microbiology; D013297:Streptococcus pyogenes