Green pus in the subdural space and within the ventricles: an uncommon finding but a straightforward macroscopic diagnosis

Excerpt

A 69-year-old man with a history of HIV infection and coronary heart disease was the victim of a physical assault. He was taken to the ED for a massive oral hemorrhage. Neurological conditions were severely compromised (GCS 3). A CT scan showed a subdural and intraparenchymal hemorrhage in the right parietal region and a laryngeal hematoma. He underwent an endotracheal intubation, and soon after a surgical evacuation of the intracranial hemorrhage was performed. His neurological status remained severely impaired. On day 18, the patient became febrile and his general condition rapidly worsened. BAL fluid examination was positive for Pseudomonas aeruginosa ciprofloxacin-sensitive, so he was prescribed antimicrobial therapy. He rapidly developed hemodynamic instability and renal failure, so he began hemodialysis treatment. Cerebrospinal fluid microbiological analysis showed a P. aeruginosa infection. The patient died on day 22 and a forensic autopsy was requested by the Prosecutor. …