Pediatric intracranial subdural empyema caused by Mycobacterium tuberculosis-a case report and review of literature

Intracranial subdural tubercular empyema is an extremely rare entity. To our knowledge, only one such case has been previously reported in the pediatric population (Cayli et al. J Neurosurg 94(6):988-991, 2001). We report a case of intracranial tubercular subdural empyema in a child, with both convexity and interhemispheric fissure involvement. A 12-year-old boy with history of exposure to an active case of pulmonary tuberculosis (his father) presented to our institution with features of raised intracranial pressure and fever for 1 month and altered sensorium for 2 days. Computerized tomography (contrast enhanced) revealed a left fronto-parietal and interhemispheric subdural space abscess. A left fronto-parietal craniotomy was performed and the subdural empyema was evacuated, and adjacent calvarium was normal. Ziehl-Neelsen staining revealed acid-fast bacilli and the subsequent polymerase chain reaction test was positive. Histopathological examination showed granulation tissue including scattered multinucleated giant cells and caseation. Mycobacterium tuberculosis bacilli were the sole organisms cultured after 6 weeks. Anti-tuberculous treatment was given in appropriate doses for 18 months at the end of which the patient was doing well with no deficits. Intracranial tubercular subdural empyema in the pediatric age group is an extremely rare but curable entity.