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Infected Scalp Hematoma Presenting With Low-Grade Fever and Significant Weight Loss

Agrawal, Amit MCh; Kumar, Anand MS; Thapa, Amit MS; Sinha, Abhishek MBBS

Infectious Diseases in Clinical Practice: January 2007 - Volume 15 - Issue 1 - p 74
doi: 10.1097/01.idc.0000239723.78078.5e
Letter to the Editors

Department of Surgery, BP Koirala Institute of Health Sciences, Dharan, Nepal

To the Editors:

The most common cause of scalp abscess is the direct inoculation of microbes into the subgaleal space after scalp trauma (laceration, or puncture wounds).1 Subgaleal abscess formation without an overlying wound is rarely reported.2 This 17-year-old male patient presented with a history of a hit by a blunt object 2 months earlier and had subgaleal hematoma with no open wound. An x-ray examination of the skull revealed a linear fracture of the occipital bone. The patient was treated conservatively. Now, he presented with persistent, painful scalp swelling, low-grade fever without chills and rigors, and significant weight loss (5 kg in the last 22 days). A computed tomographic scan showed subgaleal collection and linear fracture of the occipital bone. He underwent incision and drainage of scalp lesion; consequently, around 250 mL of thick, yellowish non-foul-smelling pus came out. Gram stain showed Gram-positive cocci in pairs, and culture showed Staphylococcus aureus sensitive to gentamicin and erythromycin. The patient recovered with daily dressing and antibiotics.

The diagnosis and treatment of subgaleal abscess is most often self-evident and straightforward.1 However, these lesions are frequently associated with extended morbidity, and the diagnosis may not be initially obvious.1 Subgaleal abscess in these patients may result from hematogenous infection or contiguous spread from calvarial osteomyelitis.1 However, there was no evident cause in this patient's case. Once the subgaleal area is infected, the inflammation spreads rapidly within the large closed space, threatening the viability of scalp and bone. Intracranial suppuration may result from secondary infection through emissary veins, calvarial foramina, fracture lines, or surgical openings in the bone.1 Diagnosis is usually made on the basis of prolonged swelling, an elevated erythrocyte sedimentation rate, and a computed tomography scan that shows a subgaleal fluid collection.2 The preferred treatment of subgaleal abscess is surgical incision with meticulous debridement and vigorous cleansing of the subgaleal space. This should be followed by appropriate systemic antibiotic therapy for 1 week and oral antibiotics for an additional week.1

Amit Agrawal, MCh

Anand Kumar, MS

Amit Thapa, MS

Abhishek Sinha, MBBS

Department of Surgery

BP Koirala Institute of Health Sciences

Dharan, Nepal

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1. Goodman SJ, Cahan L, Chow AW. Subgaleal abscess-a preventable complication of scalp trauma. West J Med. 1977;127:169-172.
2. Wiley JF, Sugarman JM, Bell LM. Subgaleal abscess: an unusual presentation. Ann Emerg Med.1989;18:785-787.
© 2007 Lippincott Williams & Wilkins, Inc.