一名14岁女性最初被诊断为脑膜炎的硬膜下积脓：一例罕见的星座链球菌感染的病例报告。

文献信息

中文摘要

背景： 硬膜下积脓（SDE）是一种不常见、可能危及生命的颅内感染，可表现为脑膜炎样特征，造成诊断困难。星座链球菌是咽峡炎链球菌群的一员，是青少年中枢神经系统感染的罕见病因，但以其形成脓肿的倾向而闻名。
病例介绍： 我们报告一名既往健康的14岁女性，在上呼吸道感染并伴有恶臭鼻分泌物后，出现急性剧烈头痛、颈项强直、畏光和呕吐。实验室检查显示明显的全身炎症（C反应蛋白>320 mg/L）和中性粒细胞增多。头部CT显示右侧6毫米硬膜下积液伴中线移位；磁共振成像证实为SDE，伴有软脑膜强化和扩散受限。她接受了内镜下鼻窦手术和双侧开颅术以清除积脓并进行颅内压监测；术中从脓性积液中采集的培养物生长出星座链球菌。治疗包括针对性静脉抗生素和早期神经康复。患者表现出稳步改善，临床和实验室检查结果均证实了这一点。
结论： 本病例强调SDE在青少年中可类似脑膜炎，并强调在存在脑膜刺激征之外还出现局灶性神经功能缺损时，应怀疑SDE的重要性。早期神经影像学检查、及时的联合手术源头控制（包括鼻窦引流）以及根据培养结果指导的抗微生物治疗对于获得良好结局至关重要。临床医生应将星座链球菌视为鼻窦相关颅内积脓的可能病原体。

英文摘要

BACKGROUND: Subdural empyema (SDE) is an uncommon, potentially life-threatening intracranial infection that can present with meningitis-like features, causing a diagnostic challenge. Streptococcus constellatus, a member of the Streptococcus anginosus group, is an unusual cause of central nervous system infections in adolescents, but is well known for its propensity to form abscesses.
CASE PRESENTATION: We report a previously healthy 14-year-old female who presented with acute severe headache, neck stiffness, photophobia, and vomiting following an upper respiratory illness with foul-smelling nasal discharge. Laboratory testing showed marked systemic inflammation (C-reactive protein >320 mg/L) and neutrophilia. Head CT demonstrated a right-sided 6-mm subdural collection with midline shift; magnetic resonance imaging confirmed a SDE with leptomeningeal enhancement and restricted diffusion. She underwent endoscopic sinus surgery and bilateral craniotomy for evacuation of the empyema with intracranial pressure monitoring; intraoperative cultures from the purulent collection grew S. constellatus. Management included targeted intravenous antibiotics and early neurorehabilitation. The patient exhibited steady improvement, as evidenced by clinical and laboratory findings.
CONCLUSION: This case highlights that SDE can mimic meningitis in adolescents and underscores the importance of suspecting SDE in the presence of focal neurological deficits in addition to meningeal signs. Early neuroimaging, prompt combined surgical source control (including sinus drainage), and culture-directed antimicrobial therapy are essential for favorable outcomes. Clinicians should consider S. constellatus as a possible pathogen in sinus-associated intracranial empyema.