Severe herpetic encephalitis in an African schoolchild: case report

Abstract

Introduction: Subdural empyema (ESD) is a collection of pus between the dura mater and arachnoid, and constitutes a medical emergency due to its rapid progression and high mortality rate. Although ENT infections are the main causes, odontogenic infections can also lead to ESD. Early diagnosis, intravenous antibiotic therapy and surgical intervention are essential to reduce mortality.
Clinical case: A 32-year-old male patient presented with a month-long picture of swelling and pain on the left side of the face, recently aggravated by fever, headache, vomiting and generalised tonic-clonic convulsions. He had a history of alcoholism and recurrent dental infections. Imaging revealed a bilateral subdural empyema with left-sided predominance. Urgent antibiotic treatment was initiated, followed by bilateral craniotomy and drainage of purulent material. In addition, a brain abscess and a subgaleal haematoma were managed. Cultures identified Streptococcus viridans and coagulase-negative Staphylococcus, with good response to targeted therapy. The patient progressed favourably and was discharged in good condition.
Conclusions: In regions like Bolivia, the prevalence of odontogenic infections due to cultural and economic factors increases the risk of severe complications such as SDE. A multidisciplinary approach, including early diagnosis, broad-spectrum antibiotics, and surgical intervention, is essential to improve outcomes and reduce mortality in these patients