INTRODUCTION: We present the first case of a subdural empyema caused by 
Streptococcus pluranimalium, in a healthy adolescent male as a possible 
complication of subclinical frontal sinusitis. Clinical features, diagnostic 
approach and management of subdural empyema are discussed.
PRESENTATION OF CASE: A 17-year-old male with a 2 day history of headache and 
nausea was referred to our Emergency Department (ED) as a case of possible 
meningitis. He was afebrile, lethargic and drowsy with significant neck 
stiffness on examination. Computerized tomography (CT) revealed a large 
frontotemporoparietal subdural fluid collection with significant midline shift. 
Subsequent contrast-enhanced CT established the presence of intracranial 
empyema; the patient underwent immediate burr-hole evacuation of the pus and 
received 7 weeks of intravenous antibiotics, recovering with no residual 
neurological deficit.
DISCUSSION: The diagnosis of subdural empyema as a complication of asymptomatic 
sinusitis in an immunocompetent patient with no history of fever or upper 
respiratory symptoms was unanticipated. Furthermore, the organism Streptococcus 
pluranimalium that was cultured from the pus has only been documented twice 
previously in medical literature to cause infection in humans, as it is 
primarily a pathogen responsible for infection in bovine and avian species.
CONCLUSION: Subdural empyema represents a neurosurgical emergency and if left 
untreated is invariably fatal. Rapid diagnosis, surgical intervention and 
intensive antibiotic therapy improve both morbidity and mortality.