Infected cephalhaematoma in a five-week-old infant - case report and review of the literature.

BACKGROUND: A cephalhaematoma is usually a benign condition which resolves spontaneously. Nevertheless, there is a small risk of primary or secondary infection and diagnosis of this condition is challenging. The purpose of this article is to summarise risk factors, clinical criteria, pathogenesis, appropriate investigations and treatment methods for infected cephalhaematomas in infants. CASE PRESENTATION: A 5-week-old infant presented with fever and a non-tender cephalhaematoma without local signs of inflammation. The inflammatory markers in blood were elevated. Urine, blood and cerebrospinal fluid cultures were sterile. The raised inflammatory markers did not decrease under antibiotic treatment. An aspirate of the cephalhaematoma grew Escherichia coli. A debridement and evacuation of the haematoma was performed and the infant was treated with antibiotics for 11 days. The infant did not show any sequelae on follow-up visits. CONCLUSIONS: We present a case of an infected cephalhaematoma with Escherichia coli in a 5-week-old infant. Diagnosis of an infected cephalhaematoma is challenging. Infection should be suspected if infant present with secondary enlargement of the haematoma, erythema, fluctuance, skin lesions or signs of systemic infection. Inflammatory markers and imaging have limited diagnostic power. The main associations with infection of cephalhaematomas are instrumental assisted deliveries and sepsis, followed by the use of scalp electrodes, skin abrasions and prolonged rupture of membranes. Although, aspiration is contraindicated in treatment of cephalhaematomas, it needs to be performed when an infection is suspected. Escherichia coli are the most frequently isolated bacteria from infected cephalhaematomas.

Primary Candida albicans empyema associated with epidural hematomas in craniocervical junction.

The case of a 27-year-old patient with chronic candida empyema in the craniocervical junction is presented. Occlusive hydrocephalus at admittance, primary subdural candida empyema, and recurrent epidural bleedings are the outstanding features in the clinical course. Despite intact immunity this patient acquired primary candidosis of CNS. Pathological changes in dura, ventricular system, and CSF required multiple shunt revisions. Antimycotic therapy was performed with a combination of 3 antimycotics. The clinical improvement was prolonged by several complications.