Severe purulent meningoencephalitis secondary to bilateral frontal sinusitis with right fronto-parietal empyema – case report

Abstract

Background. Intracranial infections secondary to ENT pathology are rare complications but may cause severe neurological impairment and increased mortality. Untreated frontal sinusitis can progress to subdural empyema and purulent meningoencephalitis, requiring early diagnosis and prompt neurosurgical treatment. Objective(s). Importance of rapid management in a severe case of purulent meningoencephalitis with right subdural empyema, status epilepticus and Staphylococcus spp. sepsis in an adolescent with untreated epilepsy. Materials and methods. The 16-year-old patient was admitted in critical condition, presenting with persistent fever, generalized tonic-clonic seizures, and altered consciousness. Paraclinical investigations included brain imaging (MRI and CT), complex microbiological analyses, multiplex PCR, repeated lumbar punctures and interdisciplinary evaluations. Results. The patient’s final diagnosis included severe purulent meningoencephalitis, right fronto-parietal subdural empyema, superior sagittal sinus thrombosis, and bacterial sepsis caused by Staphylococcus spp. Treatment involved craniotomy for neurosurgical drainage, targeted high-line antibiotic therapy based on antibiogram, anticonvulsant therapy, corticosteroids, and complex intensive care. Paraclinical investigations were essential in monitoring clinical progression. The patient’s evolution was slowly favorable, with complete neurological recovery and no major sequelae at discharge, emphasizing the importance of a multidisciplinary approach. Conclusion(s). Severe neurological complications of untreated sinusitis, such as subdural empyema and purulent meningoencephalitis, represent neurosurgical emergencies requiring prompt intervention and multidisciplinary management to reduce mortality and prevent permanent neurological sequelae.