Meningitis and subdural empyema caused by group A streptococcal infection

Group A streptococcus (GAS) could lead to various disease types in children, but central nervous system (CNS) infections are uncommon. In this paper, we analyzed the clinical features of a GAS case with meningitis and subdural empyema, and characterized the GAS clone. A thirteen-year-old boy complained of fever, headache, and left hemiplegia. Physical examination also showed central facial palsy of left side. The examinations of blood and cloudy cerebrospinal fluid (CSF) showed bacterial meningitis. Blood cultures and metagenomic sequencing (mNGS) of CSF showed GAS, and GAS antigen of throat swab was positive. The first anti-streptolysin (ASO) was negative, but increased obviously after 2 weeks. The examination of emm type showed emm 12.0 isolate. The head MRI showed restricted diffusion in the right frontal lobe, subdural empyema in the right side of cerebral falx, and meningitis. The CT revealed rhinosinusitis and mastoiditis. Bacterial meningitis, subdural empyema, sepsis, and sinusitis were diagnosed, and vancomycin and ceftriaxone were given. The patient also received dexamethasone in the beginning. Gradual improvement was seen in the patient’s clinical status, laboratory parameters (blood/CSF), and radiographic manifestations. The contiguous spread from rhinosinusitis could lead to meningitis and intracranial abscess in adolescent. GAS infection could be the pathogen for subdural empyema in patients with an abrupt onset of symptoms and rapidly deteriorating clinical course.