Colecciones posquirúrgicas extraaxiales persistentes e infección por Propionibacterium acnes. Presentación de dos casos y revisión de la literatura / Persistent extra-axial post-surgical collections and Propionibacterium acnes infection. Presentation of two cases and literature review

Objetivos: Es frecuente observar la persistencia de colecciones extraaxiales tras craneotomías. La mayoría de estas, desaparecen en semanas o meses pero algunas perduran. La aparición de clínica focal o el crecimiento de estas colecciones persistentes meses o años después de la cirugía pueden indicar la presencia de una infección crónica y latente por gérmenes de baja virulencia como Propionibacterium acnes (P. acnes). Métodos: Presentamos dos casos clínicos con colecciones extraaxiales persistentes, que precisaron cirugía, años después de su diagnóstico, en los que se aisló P. acnes como agente etiológico y revisamos la literatura publicada al respecto. Resultados: Se trata de dos pacientes que posterior a procedimientos quirúrgicos (craniectomía descompresiva por TCE grave y craneotomía por meningioma parietal derecho) desarrollaron colecciones extraaxiales que se mantuvieron vigiladas en el tiempo y que luego se infectaron y precisaron evacuación urgente de las mismas. En estas coleccionas creció el P. acnes como agente causal y precisó antibioterapia dirigida. Conclusiones: Debemos tomar en cuenta al P. acnes como agente infeccioso de colecciones posquirúrgicas de larga evolución. La presentación atípica y los cambios radiológicos pueden ser de ayuda en el diagnóstico

Objectives: It is common to observe the persistence of extra-axial collections after craniotomies. Most of these disappear in weeks or months but some remain. The onset of focal symptoms or the growth of these persistent collections months or years after surgery may indicate the presence of a chronic and latent infection by germs of low virulence such as Propionibacterium acnes (P. acnes). Methods: We present two clinical cases with persistent extra-axial collections, which required surgery years after diagnosis, in which P. acnes was isolated as an aetiological agent and we reviewed the literature published in this regard. Results: These are two patients who, following surgical procedures (decompressive craniectomy for severe TBI and craniotomy for right parietal meningioma) and extra-axial collections were kept, which were monitored over time and then were infected and required emergency evacuation. In these collections P. acnes grew as a causal agent and required targeted antibiotics. Conclusions: We must consider P. acnes as an infectious agent of post-surgical collections of long evolution. Atypical presentation and radiological changes may be helpful in diagnosis

Persistent extra-axial post-surgical collections and Propionibacterium acnes infection. Presentation of two cases and literature review. / Colecciones posquirúrgicas extraaxiales persistentes e infección por Propionibacterium acnes. Presentación de dos casos y revisión de la literatura.

OBJECTIVES: It is common to observe the persistence of extra-axial collections after craniotomies. Most of these disappear in weeks or months but some remain. The onset of focal symptoms or the growth of these persistent collections months or years after surgery may indicate the presence of a chronic and latent infection by germs of low virulence such as Propionibacterium acnes (P. acnes). METHODS: We present two clinical cases with persistent extra-axial collections, which required surgery years after diagnosis, in which P. acnes was isolated as an aetiological agent and we reviewed the literature published in this regard. RESULTS: These are two patients who, following surgical procedures (decompressive craniectomy for severe TBI and craniotomy for right parietal meningioma) and extra-axial collections were kept, which were monitored over time and then were infected and required emergency evacuation. In these collections P. acnes grew as a causal agent and required targeted antibiotics. CONCLUSIONS: We must consider P. acnes as an infectious agent of post-surgical collections of long evolution. Atypical presentation and radiological changes may be helpful in diagnosis.