Neonatal Subdural Empyema Due to Salmonella typhimurium

A 1-month-old male infant presented to the emergency room with an acute onset of fever and seizures. The patient was admitted to the neonatal intensive care unit and evaluated. Blood work showed elevated C-reactive protein and neutrophilic leucocytosis, while cerebrospinal fluid analysis revealed an elevated white blood cell count, suggestive of acute bacterial meningitis. He was initiated on piperacillin-tazobactam, amikacin, and antiepileptics. Owing to the presence of apnoea, he required continuous positive airway pressure support for 2 days, after which his general condition improved. However, on day 6 of admission, he developed multiple right focal seizures. Although there was a partial reduction in C-reactive protein and leucocyte levels, neuroimaging revealed the presence of left subdural empyema. Under ultrasound guidance, pus was aspirated, and Salmonella typhimurium grew in culture. Polymerase chain reaction testing of the cerebrospinal fluid also revealed the same organism. The baby was treated with meropenem for a total duration of IV antibiotics of 5 weeks. His antiepileptic therapy was rationalized, and he was discharged on levetiracetam. At 18 months of follow-up, the baby was seizure-free and had attained the appropriate developmental milestones. This review highlights the importance of evaluating focal seizures in infants with acute bacterial meningitis and initiating timely treatment to achieve desirable outcomes.