A Case Report of Aggressive Clostridium Septicum Pneumocephalus in the Setting of Hemolytic Uremic Syndrome
Praneeth Thadi1, Anna Thadi2, Andrew Sefain1, Joyce Jimenez Zambrano1, Mohamad Saifeddine3
1University of North Dakota, 2University of Mary, 3Sanford Children's Specialty Clinic
Objective:

To increase awareness on a rare case of rapidly progressive pneumocephalus due to Clostridium septicum and importance of starting empiric antibiotics when there is altered mental status in setting of hemolytic uremic syndrome.

Background:
Hemolytic uremic syndrome (HUS) is rare thrombotic microangiopathy that results in hemolytic anemia, thrombocytopenia, and acute kidney injury commonly caused by bacterial toxins. Clostridium septicum is a rare cause of HUS. The hematogenous spread of this infection to the brain leading to rapid pneumocephalus is rare.
Design/Methods:
N/A
Results:

A 21-month-old boy was seen in the emergency department (ED) for a 3-day history of nausea, vomiting and diarrhea. He had more than 30 bowel movements the day prior. He was discharged with recommendations to increase oral fluid intake and ondansetron as needed. Symptoms persisted and he returned 2 days later to the ED with systemic symptoms and abnormal laboratory studies concerning for HUS secondary to Escherichia coli. Intravenous fluids and continuous renal replacement therapy were started. Acute clinical decline led to Pediatric intensive care unit admission the next day. One day later, he developed altered mental status with fixed and dilated pupils. Computerized tomography of the head showed mild pneumocephalus in the left hemispheric convexity. Within a span of 4 hours, the infection spread to the majority of the left cerebral hemisphere despite starting piperacillin/ tazobactam and meropenem. 7 hours later, there was generalized loss of brain parenchyma. Cerebrospinal fluid cultures showed Clostridium septicum. Autopsy revealed pneumocephalus secondary to Clostridium septicum.

Conclusions:
In cases of HUS with subsequent changes in mental status, emergent head imaging can provide life saving time for intervention/management especially in such cases of aggressive bacterial toxins. Delay in starting empiric broad spectrum antibiotics can lead to increased mortality and morbidity.
10.1212/WNL.0000000000208525
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