This is a 70-year-old female patient with no relevant past medical history, living in the rural area of Antioquia, Colombia, who underwent resection of a pituitary macroadenoma affecting the left optic tract, producing prolactin.
The hospital's Neurosurgery Group was responsible for transcranial tumor resection, with no complications occurring in the immediate postoperative period.
Six weeks after surgery, the patient developed edema and erythema in the surgical area, which progressed despite initial treatment with cefazolin and clindamycin in the local hospital, so she was referred to our institution.
On physical examination at admission, the patient presented erythema, heat, purulent discharge from the surgical wound, and ipsilateral peptavial inflammatory ptosis, without periorbital involvement.
The results of the initial laboratory tests revealed a normal white blood cell count (6,610 cells/mm 3, neutrophils:
C-reactive protein, erythrocyte sedimentation rate, renal function and electrolytes were normal.
Simple and contrast computed tomography showed a liquid collection epidural without mesh 8 mm and meningeal uptake of contrast medium at the level of the left parietal bone; as well as a small collection of fluid in the white soft tissues.
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A craniotomy was performed, the fluid collection (100 ml in the epidural region and 10 ml in the subdural) was drained and samples were taken for culture.
Three days after the surgical procedure, growth of Gram-negative bacilli was obtained in cultured cultures, while type-relations were subsequently typified in the epidural and subdural zones.
Isolation was confirmed using the Vitek® 2 compact identification system and confirmed with the Phoenix® system, with a 99% confidence interval in both cases.
Based on the sensitivity profile, antibiotic treatment was switched to 400 mg of ciprofloxacin every 8 hours intravenously; given the favorable evolution of the patient, it was decided to complete 42 days of treatment with 750 mg orally every 12 hours.
One year later, there was no recurrence of the infection.
