Suppurative intracranial complications of acute bacterial sinusitis in a neurodivergent child: a case of subdural empyema, septic shock, and delayed diagnosis

Suppurative intracranial complications of acute bacterial sinusitis are rare but cause significant morbidity in children. Diagnosis is often delayed because of the nonspecific nature of symptoms, which often include headache and fever early in the courses. We describe a 12-year-old girl presenting with fever, cough, and a Glasgow Coma Scale of 5, which was secondary to acute bacterial sinusitis with contiguous spread, leading to a subdural empyema. This was complicated by septic shock. The initial diagnosis was slowed by the pursuit of differential diagnoses of altered mental status in a patient who presented after a head injury, alongside other comorbidities, such as epilepsy and developmental delay. She recovered following surgical source control, prolonged antibiotics, and neurorehabilitation. Early recognition of this uncommon but important diagnosis can lead to improved outcomes but can be particularly challenging in neurodivergent children who may not be able to communicate the classic symptoms.