RESUMEN
We report a case of neonatal subdural empyema caused by Mycoplasma hominis. The infant sustained severe birth-related eye injury and subsequently developed multiple subdural empyemata. This report illustrates the clinical presentation of this unusual infection and the crucial role of neurosurgical intervention and specific antimicrobial therapy for its successful management.
Asunto(s)
Antibacterianos/uso terapéutico , Empiema Subdural/tratamiento farmacológico , Minociclina/uso terapéutico , Infecciones por Mycoplasma/tratamiento farmacológico , Mycoplasma hominis/aislamiento & purificación , Traumatismos del Nacimiento/etiología , Traumatismos del Nacimiento/microbiología , Traumatismos del Nacimiento/patología , Empiema Subdural/microbiología , Empiema Subdural/patología , Lesiones Oculares/etiología , Lesiones Oculares/microbiología , Lesiones Oculares/patología , Femenino , Humanos , Recién Nacido , Inyecciones Intravenosas , Pruebas de Sensibilidad Microbiana , Infecciones por Mycoplasma/complicaciones , Infecciones por Mycoplasma/patología , Mycoplasma hominis/fisiología , Forceps Obstétrico/efectos adversos , Resultado del TratamientoRESUMEN
A 4-year-old boy had surgical debulking of a cerebral astrocytoma followed by chemotherapy. He developed a subdural empyema with a teicoplanin and methicillin resistant Staphylococcus aureus. He was successfully treated with surgical drainage and 6 weeks of antibiotic therapy which included linezolid, rifampicin and metronidazole. Linezolid may be successful in treating other CNS infections caused by antibiotic resistant gram-positive organisms.
Asunto(s)
Acetamidas/uso terapéutico , Antiinfecciosos/uso terapéutico , Farmacorresistencia Bacteriana Múltiple , Empiema Subdural/microbiología , Empiema Subdural/terapia , Staphylococcus aureus Resistente a Meticilina , Oxazolidinonas/uso terapéutico , Infecciones Estafilocócicas/tratamiento farmacológico , Preescolar , Drenaje , Quimioterapia Combinada , Humanos , Linezolid , Masculino , Pruebas de Sensibilidad Microbiana , Rifampin/uso terapéutico , Teicoplanina/uso terapéuticoRESUMEN
OBJECTIVE AND IMPORTANCE: This case demonstrates a relationship between hydrocephalus with a huge diverticulum of the third ventricle and high serum levels of somatomedin-C. Somatomedin-C levels become high when the secretion of growth hormone from the adenohypophysis increases, and previous reports state that hydrocephalus decreases the secretion of growth hormone. CLINICAL PRESENTATION: The patient suffered from diabetes mellitus and obesity, and serum somatomedin-C levels were high. A pituitary adenoma or ectopic growth hormone-producing tumor was suspected. Magnetic resonance imaging did not reveal either of these abnormalities but indicated hydrocephalus with a diverticulum of the third ventricle. INTERVENTION: After ventriculoperitoneal shunt placement, the blood glucose and serum somatomedin-C levels of the patient decreased toward normal. Six months later, the shunt tube became obstructed and serum somatomedin levels increased. The levels decreased again after shunt revision. CONCLUSION: To our knowledge, this is the first published report of obstructive hydrocephalus with a diverticulum of the third ventricle compressing the hypothalamus and increasing the serum levels of somatomedin-C.
Asunto(s)
Diabetes Mellitus Tipo 1/complicaciones , Hidrocefalia/etiología , Factor I del Crecimiento Similar a la Insulina/análisis , Adenoma/diagnóstico , Adolescente , Encefalopatías/diagnóstico , Quistes/diagnóstico , Diagnóstico Diferencial , Diplopía/etiología , Empiema Subdural/etiología , Empiema Subdural/microbiología , Enterococcus/aislamiento & purificación , Femenino , Sinusitis Frontal/complicaciones , Sinusitis Frontal/microbiología , Sinusitis Frontal/cirugía , Hormona Liberadora de Gonadotropina , Infecciones por Bacterias Grampositivas/complicaciones , Infecciones por Bacterias Grampositivas/microbiología , Infecciones por Bacterias Grampositivas/cirugía , Hormona Liberadora de Hormona del Crecimiento , Cefalea/etiología , Hemiplejía/etiología , Hormona de Crecimiento Humana/metabolismo , Humanos , Hidrocefalia/diagnóstico , Hidrocefalia/cirugía , Sistema Hipotálamo-Hipofisario/fisiopatología , Hipotálamo/metabolismo , Hipotálamo/patología , Factor I del Crecimiento Similar a la Insulina/metabolismo , Imagen por Resonancia Magnética , Adenohipófisis/metabolismo , Hormonas Hipofisarias/metabolismo , Neoplasias Hipofisarias/diagnóstico , Tasa de Secreción , Convulsiones/etiología , Hormona Liberadora de Tirotropina , Derivación VentriculoperitonealRESUMEN
Cases of intracranial sepsis of otorhinogenic origin presenting to a regional neurosurgical centre from 1984 to 1992 were examined with regard to their microbiology and antibiotic sensitivities. The results lead us to believe that cefotaxime may have a role in the initial ENT management of the potentially complicated case of ear or sinus sepsis.