Brief Clinical StudiesManagement of a Transcranial Abscess Secondary to Interleukin-1 Receptor Associated Kinase 4 DeficiencyPidgeon, Thomas Edward MBChB*; Ahmad, Fateh FRCS†; Hackett, Scott MD‡; Rodrigues, Desiderio FRCS†; Nishikawa, Hiroshi MD†Author Information From the *University Hospital Coventry and Warwickshire National Health Service Trust, Coventry; †Department of Craniofacial Surgery, Birmingham Children’s Hospital National Health Service Trust, Birmingham, West Midlands; and ‡Department of Paediatric Immunology, Heartlands Hospital, Birmingham, United Kingdom. Received March 24, 2014. Accepted for publication June 20, 2014. Address correspondence and reprint requests to Thomas Edward Pidgeon, MBChB, University Hospital Coventry and Warwickshire National Health Service Trust, Clifford Bridge Rd, Coventry, CV2 2DX, United Kingdom; E-mail: firstname.lastname@example.org The authors report no conflicts of interest. Journal of Craniofacial Surgery: January 2015 - Volume 26 - Issue 1 - p e2-e3 doi: 10.1097/SCS.0000000000001184 Buy Metrics Abstract Interleukin-1 receptor associated kinase 4 (IRAK-4) deficiency is a primary immunodeficiency that predisposes to opportunistic pyogenic infections in affected patients. The presentation can be variable, and the microbiological and immunologic management of this condition has been documented; however, the atypical nature of its presentation calls for a different approach in its surgical management. This is the first reported case of transcranial progression of a soft tissue abscess in a patient with IRAK-4 deficiency, with an emphasis on a multidisciplinary approach to treat infection at an extremely vulnerable anatomic site. © 2015 by Mutaz B. Habal, MD.