Almost all causes of scalp abscess is are due to direct introduction of microbes into the subgaleal space after disruption of skin barrier (laceration, or puncture wounds). Infected scalp hematoma without interruption of skin barrier is rarely reported. Mr S, 35-year-old IVDU was brought by the prison officer with a complaint of worsening right sided scalp expanding hematoma for more than a month. He was assaulted with a blunt object prior to that and did not seek any medical treatment up until the current visit. He denied of any external wound or bleeding from the site during the attack. Other than the pain over the scalp, he did not have fever, loss of appetite or change in behavior. Computer tomographic scan showed right subgaleal collection with extradural extension and right temporal bone fracture. He was referred to neurosurgical team and subsequently a craniectomy, exploration and evacuation of abscess was done. Intra operatively, the temporalis muscle was unhealthy with sloughy dura. He was started on antibiotic and discharged home well.
The diagnosis and treatment of subgaleal abscess are often not complicated. Nevertheless, this condition is usually affiliated with extended morbidities such as seizure or sepsis and diagnosis might be missed initially. High level of suspicion of an abscess is especially suspected in the immunocompromised with non resolving and expanding hematoma. Identification of this condition is usually made with history of prolonged swelling, increased inflammatory markers and a computer tomography scan that showed subgaleal collection. The recommended treatment is surgical incision and careful debridement followed by appropriate systemic antimicrobial therapy for a week with continuation of oral therapy for another week.