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CC BY-NC-ND 4.0 · Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery 2023; 42(03): e250-e255
DOI: 10.1055/s-0042-1758211
Case Report

Rare Presentation of Morganella morganii Microorganism as Epidural and Subdural Empyema

Apresentação rara de Morganella morganii Microrganismo como Empiema Epidural e Subdural
Suleiman S. Daoud 
1   Neurosurgery Department, Faculty of Medicine, Jordan University of Science & Technology, Irbid, Jordan
,
Sultan Jarrar 
1   Neurosurgery Department, Faculty of Medicine, Jordan University of Science & Technology, Irbid, Jordan
,
Obada E. Ababneh 
2   Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
,
Omar F. Jbarah 
1   Neurosurgery Department, Faculty of Medicine, Jordan University of Science & Technology, Irbid, Jordan
› Author Affiliations Funding The present study did not receive any funding from either public, private, or not-for-profit sources.
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Abstract

Background Morganella morganii is a gram-negative bacterium that rarely infects the central nervous system (CNS). Few reports described such an infection in the CNS. We present a case of extremely invasive M. morganii infection in the CNS. In addition, we performed a literature review of M. morganii infection in the CNS.

Case report A 53-year-old male was admitted to the hospital due to fever, general weakness, and left-sided facial muscle twitching. He had a history of diabetes mellitus, hypertension, brain tumor, and epilepsy. Multiple left frontal scalp ulcers were revealed. In addition, a computed tomography (CT) scan and magnetic resonance imaging (MRI) revealed a left side epidural abscess and subdural empyema. Moreover, the patient had left frontal bone osteomyelitis. The next day, the patient underwent craniectomy, was transferred to the intensive care unit and started an empirical antibiotic course. Morganella morganii was identified from the infected scalp ulcers. On the 13th day, the patient passed away due to uncontrolled status epilepticus.

Conclusion M. morganii can cause isolated or multiple types of CNS infections, including brain abscess, meningitis, and subdural empyema. The mortality rate may differ according to age and to the use of surgical evacuation.

Resumo

Introdução Morganella morganii é uma bactéria gram-negativa que raramente infecta o sistema nervoso central (SNC). Poucos relatos descreveram tal infecção no SNC. Apresentamos um caso de infecção extremamente invasiva por M. morganii no SNC. Além disso, realizamos uma revisão da literatura sobre a infecção por M. morganii no SNC.

Relato de caso Um homem de 53 anos foi admitido no hospital devido a febre, fraqueza geral e espasmos da musculatura facial do lado esquerdo. Ele tinha história de diabetes mellitus, hipertensão, tumor cerebral e epilepsia. Múltiplas úlceras no couro cabeludo frontal esquerdo foram reveladas. Além disso, uma tomografia computadorizada (TC) e uma ressonância magnética (RM) revelaram um abscesso epidural do lado esquerdo e empiema subdural. Além disso, o paciente apresentava osteomielite do osso frontal esquerdo. No dia seguinte, o paciente foi submetido à craniectomia, foi transferido para a unidade de terapia intensiva e iniciou curso empírico de antibiótico. Morganella morganii foi identificada a partir das úlceras do couro cabeludo infectadas. No 13° dia, o paciente faleceu devido a estado de mal epiléptico não controlado.

Conclusão M. morganii pode causar tipos isolados ou múltiplos de infecções do SNC, incluindo abscesso cerebral, meningite e empiema subdural. A taxa de mortalidade pode diferir de acordo com a idade e com o uso da evacuação cirúrgica.

Keywords

subdural empyema - morganella morganii - brain infection - scalp ulcer

Palavras-chave

Empiema Subdural - Morganella morganii - Infecção cerebral - Úlcera do couro cabeludo

Ethics Approval and Consent to Participate

Written informed consent was obtained from the patient for publication of the case report and any related images.




Publication History

Received: 15 March 2022

Accepted: 01 August 2022

Article published online:
29 September 2023

© 2022. Sociedade Brasileira de Neurocirurgia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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