Late onset subgaleal hemorrhage infection with Streptococcus pneumoniae?

Abstract

We report a case of an infected subgaleal hematoma caused by an unusual micro-organism in a previously healthy 11-month-old girl. Our patient presented at the emergency department with an increasing scalp swelling for 2 weeks, and culture of the evacuated fluid yielded Streptococcus pneumoniae. Although she was born after vacuum delivery and a scalp swelling was noticed from the third day of life, this swelling disappeared completely at the age of 3 months. Parents were thoroughly questioned but we could not find out a new traumatic head event. We postulate that in our patient, a subgaleal hemorrhage developed after vacuum delivery and possibly infected 11 months later, presumably from hematogenous seeding of an acute otitis media. The patient recovered well after surgical drainage and antimicrobial therapy.

Infected Subgaleal Hematoma Following Blunt Head Trauma in a Child: Case Report and Review of the Literature

“…In all previously described cases, needle aspiration is performed and aspirate contents sent for Gram stain/ culture. This is often followed by surgical drainage, as occurred in our patient [6,11,25,26] . The choice for operative drainage should be carefully considered, as it may remove the tamponade effect of the surrounding tissues on the hematoma leading to additional hemorrhage into the adjacent subgaleal space.…”

“…Pollack et al [11] reported an infected SGH that presented 6 days after vacuum delivery with a polymicrobial flora. Slap et al [25] reported an SGH infected with S. pneumoniae 11 months after a vacuum delivery and temporally associated with otitis media. Ogunrinde et al [26] reported a 9-day-old baby delivered at home who presented to the hospital with an enlarging scalp hematoma without signs of skin breakdown.…”