Rare Presentation of Morganella morganii Microorganism as Epidural and Subdural Empyema / Apresentação rara de Morganella morganii Microrganismo como Empiema Epidural e Subdural

Background Morganella morganii is a gram-negative bacterium that rarely infects the central nervous system (CNS). Few reports described such an infection in the CNS. We present a case of extremely invasive M. morganii infection in the CNS. In addition, we performed a literature review of M. morganii infection in the CNS. Case report A 53-year-old male was admitted to the hospital due to fever, general weakness, and left-sided facial muscle twitching. He had a history of diabetes mellitus, hypertension, brain tumor, and epilepsy. Multiple left frontal scalp ulcers were revealed. In addition, a computed tomography (CT) scan and magnetic resonance imaging (MRI) revealed a left side epidural abscess and subdural empyema. Moreover, the patient had left frontal bone osteomyelitis. The next day, the patient underwent craniectomy, was transferred to the intensive care unit and started an empirical antibiotic course. Morganella morganii was identified from the infected scalp ulcers. On the 13th day, the patient passed away due to uncontrolled status epilepticus. Conclusion M. morganii can cause isolated or multiple types of CNS infections, including brain abscess, meningitis, and subdural empyema. The mortality rate may differ according to age and to the use of surgical evacuation.

Introdução Morganella morganii é uma bactéria gram-negativa que raramente infecta o sistema nervoso central (SNC). Poucos relatos descreveram tal infecção no SNC. Apresentamos um caso de infecção extremamente invasiva por M. morganii no SNC. Além disso, realizamos uma revisão da literatura sobre a infecção por M. morganii no SNC. Relato de caso Um homem de 53 anos foi admitido no hospital devido a febre, fraqueza geral e espasmos da musculatura facial do lado esquerdo. Ele tinha história de diabetes mellitus, hipertensão, tumor cerebral e epilepsia. Múltiplas úlceras no couro cabeludo frontal esquerdo foram reveladas. Além disso, uma tomografia computadorizada (TC) e uma ressonância magnética (RM) revelaram um abscesso epidural do lado esquerdo e empiema subdural. Além disso, o paciente apresentava osteomielite do osso frontal esquerdo. No dia seguinte, o paciente foi submetido à craniectomia, foi transferido para a unidade de terapia intensiva e iniciou curso empírico de antibiótico. Morganella morganii foi identificada a partir das úlceras do couro cabeludo infectadas. No 13° dia, o paciente faleceu devido a estado de mal epiléptico não controlado. Conclusão M. morganii pode causar tipos isolados ou múltiplos de infecções do SNC, incluindo abscesso cerebral, meningite e empiema subdural. A taxa de mortalidade pode diferir de acordo com a idade e com o uso da evacuação cirúrgica.

Management and Outcome of a Neurologically Intact Infant with Pierre Robin Sequence and Dandy-Walker Variant Diagnosed with Large Hemispheric Brain Abscess ­ Case Report

Pierre Robin sequence (PRS) is a condition consisting of three essential components: micrognathia or retrognathia, cleft palate, and glossoptosis. It can be part of multiple congenital anomalies. We present the case and outcome of a 3-month-old clinically stable patient who has PRS with Dandy-Walker variant ­ which is a rare presentation in the literature ­ with a large right hemispheric brain abscess, treated with multiple minimally-invasive surgical drainage procedures with adjuvant antibiotics.

Buckling of the Ligamentum Flavum as a Rare Complication of Anterior Cervical Corpectomy and Fusion: A Case Report

Introduction and Importance Neurological deterioration due to buckling of the ligamentum flavum (LF) is an uncommon complication after anterior cervical corpectomy or discectomy with fusion. Case Presentation In this report, we present the case of a 66-year-old male who underwent anterior cervical partial corpectomy of C5 and discectomy of prolapsed C5- C6 with fusion. Postsurgery, the patient displayed signs of neurological deterioration. Upon immediate cervical magnetic resonance imaging (MRI), posterior canal stenosis and severe compression with cord signal due to LF buckling were detected. A posterior laminectomy procedure and canal decompression at the C5-C6 level with bone fusion were performed. Clinical Discussion Patient presented with walking difficulty, then walking disability, followed by bilateral upper and lower limb paresthesia with burning sensation. Examination showed ⅘ muscle strength in both handgrips. Further investigation showed brisk deep tendon reflexes, positive Hoffman sign unilaterally, equivocal Babinski sign, and progressive quadriparesis. Magnetic resonance imaging showed mild and diffuse building of some cervical discs, with spinal cord progression. We performed an anterior cervical corpectomy and fusion (ACCF) and anterior cervical discectomy and fusion (ACDF); a titanium mesh with plates and screws was used for fusion, with removal of a calcified and herniated subligamentous disc. Postoperatively, upper and lower limb strength deteriorated; immediate cervical and thoracic MRI showed LF buckling, which caused canal stenosis and severe compression. Urgent posterior laminectomy and canal decompression with bone fusion was scheduled on the same day. The patient underwent physiotherapy and regained upper and lower limb strength and his ability to walk. Conclusion This indicates the possibility of neurological deterioration as a result of LF buckling, whichmay be a result of LF thickening accompanied by hyperextension in the cervical region. In this regard, immediate imaging following signs of neurological complications after anterior cervical corpectomy or discectomy warrants early detection, which results in a better prognosis.