Subdural Empyema: A Complication of Meningococcal Meningitis in a 3-Month-Old Infant

A bstract Meningococcal meningitis in early infancy is a fulminant illness with high neurological morbidity. While encephalitis and raised intracranial pressure are common sequelae, subdural empyema is an uncommon but life-threatening complication that may be missed due to its nonspecific presentation. A 3-month-old male infant presented with febrile status epilepticus, lethargy, and a bulging fontanel. Cerebrospinal fluid culture confirmed Neisseria meningitidis. Neuroimaging revealed cerebral edema, encephalitic changes, and bilateral subdural collections, with right-sided empyema and left-sided effusion. Antiepileptics and empirical antibiotics were initiated and later de-escalated to ceftriaxone following culture confirmation. Neurosurgical evacuation was advised, but the family opted for discharge against medical advice. Surgical drainage was subsequently performed elsewhere, and the child improved with continued antibiotic therapy. Subdural empyema, though uncommon, should be suspected in infants with meningococcal meningitis who present with refractory seizures or delayed recovery. Early imaging and combined medical–surgical management are essential for optimal outcomes.