Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jul 26, 2020; 8(14): 3114-3121
Published online Jul 26, 2020. doi: 10.12998/wjcc.v8.i14.3114
Dental focal infection-induced ventricular and spinal canal empyema: A case report
Hang Xue, Xiao-Hui Wang, Lin Shi, Qiang Wei, Yi-Ming Zhang, Hong-Fa Yang
Hang Xue, Xiao-Hui Wang, Qiang Wei, Hong-Fa Yang, Department of Neurotraumatic Surgery, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
Lin Shi, Department of Neurosurgery, The Affiliated Hospital of Changchun University of Traditional Chinese Medicine, Changchun 130021, Jilin Province, China
Yi-Ming Zhang, Department of Neurosurgery, Dong’e Hospital Affiliated to Shandong First Medical University, Dong’e 252200, Shandong Province, China
Author contributions: Yang HF contributed to case conceptualization; Xue H, Wang XH, and Yang HF contributed to data curation; Yang HF contributed to funding acquisition; Wang XH, Shi L, and Wei Q contributed to case investigation; Wang XH, Wei Q, and Yang HF contributed to resources; Shi L contributed to software and visualization; Xue H contributed to manuscript drafting, review, and editing.
Informed consent statement: Informed written consent was obtained from the patient.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Hong-Fa Yang, MD, PhD, Professor, Department of Neurotraumatic Surgery, The First Hospital of Jilin University, No. 71, Xinmin Street, Changchun 130021, Jilin Province, China. yhf@jlu.edu.cn
Received: January 11, 2020
Peer-review started: January 11, 2020
First decision: June 8, 2020
Revised: June 10, 2020
Accepted: July 4, 2020
Article in press: July 4, 2020
Published online: July 26, 2020
Processing time: 194 Days and 19.9 Hours
Abstract
BACKGROUND

Dental focal infection-induced ventricular and spinal canal empyema is an extremely rare, severe, acute disease that is clinically associated with extremely high morbidity and mortality. Traditional cerebrospinal fluid (CSF) bacterial culture is time-consuming, with a low positive rate, which frequently results in severe irreversible consequences. The next-generation sequencing technique is an emerging pathogenic microorganism detection method that can obtain results in a short time with high accuracy, thus providing great assistance in the clinical diagnosis and treatment of this disease.

CASE SUMMARY

This paper reports a rare case of dental focal infection-induced ventricular and spinal canal empyema. During the course of treatment at a local hospital, the patient had negative results from repeated CSF bacterial cultures and was empirically given vancomycin treatment. After transfer to our hospital, the next-generation sequencing technique was adopted to determine that the pathogenic microorganisms were multiple anaerobic infectious bacteria derived from the oral cavity. The antibiotic therapeutic scheme was adjusted in a timely manner, and the ventricular and spinal canal inflammation was also controlled. However, the antibiotics that had been applied at the local hospital were not able to cover all pathogenic microorganisms, which resulted in irreversible injury to the brain stem, finally leading to patient death.

CONCLUSION

Dental focal infection-induced ventricular and spinal canal empyema is an extremely rare, severe, acute disease with high morbidity and mortality. Any delay in diagnosis and treatment will result in irreversible consequences. The early application of the next-generation sequencing technique can obtain results in a short time and clarify a diagnosis. Appropriate antibiotic treatment combined with suitable surgical intervention is the key to managing this disease.

Keywords: Ventricular empyema; Next-generation sequencing; Dental focal infection; Antibiotics; Surgery; Case report

Core tip: Dental focal infection-induced ventricular and spinal canal empyema is an extremely rare severe acute disease with high morbidity and mortality. Any delay in diagnosis and treatment will result in irreversible consequences. The early application of the next-generation sequencing technique can obtain results in a short time and clarify a diagnosis. Appropriate antibiotic treatment combined with suitable surgical intervention is the key to managing this disease.