(481) First Report of Salmonella dublin Subdural Empyema: A Rare Presentation of CNS Infection

Introduction: Salmonella subdural empyema is a rare but serious infection that impacts the brain and adjacent tissues. The condition develops when Salmonella bacterium spread from an infected site to the subdural space. Contaminated animal-derived food products, such as poultry and eggs, are a potential source of nontyphoidal Salmonella infection in humans. Timely detection and immediate treatment are critical to manage this disease and avoiding severe complications. Nevertheless, its rarity and non-specific symptoms make it challenging to diagnose.

Description: An 83-year-old female with a history of lung cancer status post resection, hypertension, hyperlipidemia, and hypothyroidism, presented to the ER febrile with altered mentation, following a low impact fall sustained two weeks before her acute decline. On admission, the patient was aphasic and had RUE weakness. CT head showed acute on chronic subdural hematomas overlying the left and right cerebral convexities measuring 2 cm and 0.8 cm in thickness respectively, with associated mass effect on the left cerebral hemisphere with extensive sulcal effacement. The patient was admitted to the NICU, with plans for urgent neurosurgical hematoma evacuation later undergoing left frontal burr hole evacuation of subdural hematoma and insertion of a drain. Work-up revealed UA concerning for UTI and pulmonary infiltrate on CXR prompting initiation of empiric antibiotics. Surgical hematoma evacuation revealed a foul-smelling fluid with intra-operative cultures sent, later growing non-typhoidal Salmonella Enterica serotype Dublin. Patient was retaken to OR for reaccumulating left subdural hematoma and empyema, later medically stabilized and discharged after a 12-day admission.

Discussion: The prevalence of Salmonella enterica, serotype Dublin has increased over the past few years in the US and been detected in animal products. This case presents a rare instance of subdural empyema with Salmonella Enterica and the only reported case with the serotype Dublin, presenting as a subdural hematoma in an adult.