Streptococcus pyogenes subdural empyema not detected by computed tomography

A previously healthy 5-year-old boy presented with a non-specific febrile illness and seizures. Streptococcus pyogenes was identified in his blood culture. The spinal fluid revealed minimal pleocytosis and an axial computed tomography (CT) scan of the head was normal. Ongoing symptoms prompted a magnetic resonance imaging, which revealed a subdural empyema. Our patient diverges from the few previously reported S. pyogenes intracranial infections in that there was neither an adjacent infection nor a bacterial meningitis. In addition, we discuss the few studies addressing the sensitivity of CT for the diagnosis of bacterial intracranial infections.