Cavernous Sinus Thrombosis Secondary to Streptococcus Constellatus Pharynges.

Streptococcus constellatus pharyngis is a gram-positive commensal bacterium commonly found in the oropharynx, gastrointestinal and urogenital tracts. It might be an aggressive opportunistic pathogen causing invasive pyogenic infections in sterile areas, mostly as peritonsillar and orofacial abscesses. We report the case of a 6-year-old girl, who presented multiple head and neck abscesses and bilateral cavernous sinus thrombosis secondary to Streptococcus constellatus pharyngis. Cavernous sinus thrombosis, consequent to this microorganism, has not been reported to date in the literature. Due to the invasive features of this pathogen, a long-term antibiotherapy (up to 9 months) is required. Additionally, a surgical drainage is indicated in case of head and neck, or brain abscesses, larger than 20 or 25 mm respectively. Anticoagulation should be considered in case of venous thrombosis. The interest of this case is not only based on the rarity and severity of the disease, but also on the success of medical and surgical therapy (including long- term antibiotics, anticoagulation and two surgical procedures). This experience may serve as a guide to treat future cases. Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-024-04511-3.

Diffusion-weighted imaging-based radiomics model using automatic machine learning to differentiate cerebral cystic metastases from brain abscesses.

OBJECTIVES: To develop a radiomics model based on diffusion-weighted imaging (DWI) utilizing automated machine learning method to differentiate cerebral cystic metastases from brain abscesses. MATERIALS AND METHODS: A total of 186 patients with cerebral cystic metastases (n = 98) and brain abscesses (n = 88) from two clinical institutions were retrospectively included. The datasets (129 from institution A) were randomly portioned into separate 75% training and 25% internal testing sets. Radiomics features were extracted from DWI images using two subregions of the lesion (cystic core and solid wall). A thorough image preprocessing method was applied to DWI images to ensure the robustness of radiomics features before feature extraction. Then the Tree-based Pipeline Optimization Tool (TPOT) was utilized to search for the best optimized machine learning pipeline, using a fivefold cross-validation in the training set. The external test set (57 from institution B) was used to evaluate the model's performance. RESULTS: Seven distinct TPOT models were optimized to distinguish between cerebral cystic metastases and abscesses either based on different features combination or using wavelet transform. The optimal model demonstrated an AUC of 1.00, an accuracy of 0.97, sensitivity of 1.00, and specificity of 0.93 in the internal test set, based on the combination of cystic core and solid wall radiomics signature using wavelet transform. In the external test set, this model reached 1.00 AUC, 0.96 accuracy, 1.00 sensitivity, and 0.93 specificity. CONCLUSION: The DWI-based radiomics model established by TPOT exhibits a promising predictive capacity in distinguishing cerebral cystic metastases from abscesses.

Culture-negative endocarditis with multifocal spread and flail mitral valve leaflet: a case report.

Introduction: Blood culture-negative infective endocarditis is the condition in which a causative organism cannot be identified after inoculation of at least three samples using standard blood-culture systems for 7 days. It has a low reported incidence of about 2.5-31%. Causes may be infectious or non-infectious; use of prior antibiotic therapy is usually the leading factor. Case presentation: The authors present a case of true culture-negative endocarditis involving the mitral valve, with multiple foci of spread including brain, spleen, liver, and Intervertebral disc, which remained persistent despite treatment with intravenous broad-spectrum antibiotics on an inpatient and outpatient basis but eventually improved after upgrading alternative broad-spectrum antibiotic for an extended duration. The patient had complications in the form of a flail mitral valve with persistent mitral regurgitation, requiring mitra-clip placement. Discussion: Positive blood culture is one of the major diagnostic criteria to establish infective endocarditis. Patients may have persistent negative cultures due to previous antibiotic use, the presence of fastidious organisms, or the use of inappropriate techniques or media. Involvement of a multidisciplinary team, use of multimodal investigations, and appropriate antibiotic stewardship are crucial. Extended duration of treatment and upgrading antibiotics can be helpful next steps in highly suspicious cases. With multifocal spread as in our case, it further becomes challenging to control and treat the infection as it is frequently connected with higher morbidity and mortality. Conclusion: Blood culture-negative endocarditis is an entity that can present with early complications. It is diagnostically and therapeutically challenging to treat such patients. Multimodal approaches for early diagnosis and appropriate treatment are crucial owing to its high morbidity and mortality.

Clinical analysis, diagnosis, and treatment strategies for otogenic brain abscesses.

Objective: To explore the clinical features, diagnosis, and treatment strategies for otogenic brain abscesses (OBA). Methods: Clinical data from 10 patients with OBA were analyzed retrospectively. Clinical characteristics, diagnosis, and treatment experiences were summarized. Results: Two were first diagnosed in the Department of Otorhinolaryngology, 5 in Neurosurgery, and 3 in other departments. There were 6 cases of temporal lobe abscess and 4 cases of cerebellar abscesses. Five cases were accompanied by 1 or more intracranial complications. Headache is a common presentation in all cases. The main pathogenic bacteria were anaerobic bacteria. All patients had no previous ear or brain surgery history, and no history of traumatic brain injury, 7 received surgical treatment in the neurosurgery and/or otolaryngology department. Two patients died, the other 8 fully recovered and so were discharged. Conclusions: Diagnosis and treatment of OBA must involve multiple departments. Multidisciplinary consultation (MDT) is crucial to the success of the first OBA diagnosis. The diagnosis and treatment team develops personalized treatment plans by integrating MDT treatment opinions and combining the actual condition of patients, thereby making the diagnosis and treatment of OBA accurate and timely.

Antibiotic treatment of neuro-meningeal infections.

In France, conjugated pneumococcal vaccination has considerably modified the profile of pneumococcal meningitis by eliminating the most virulent strains resistant to beta-lactams. Over recent years, the nationwide pediatric meningitis network of the Pediatric Infectious Disease Group (GPIP) and the National Reference Centre of Pneumococci have not recorded any cases of meningitis due to pneumococcus resistant to third-generation cephalosporins (C3G), even though in 2021, strains with a less favorable profile appeared to emerge. These recent data justify renewal of the 2016 recommendations and limitation of vancomycin to the secondary phase of treatment of pneumococcal meningitis when the MIC of the isolated strain against injectable C3Gs is >0.5 mg/L. The only major change proposed by the GPIP in this 2023 update of its recommendations is discontinuation of the recommendation of a combination of ciprofloxacin and cefotaxime in Escherichia coli meningitis in newborns and young infants. The nationwide observatory of meningitis in children is a valuable tool because of its completeness and its continuity over the past 15 years. The maintenance of epidemiological surveillance will allow us to adapt new therapeutic regimens to the evolution of pneumococcal susceptibility profiles and to future serotype-specific changes. Community-acquired cerebral abscesses are rare diseases, of which the management requires a rigorous approach: high-quality imaging, bacteriological sampling prior to antibiotic therapy whenever possible, and antibiotic treatment including metronidazole in addition to cefotaxime. Multidisciplinary collaboration, including infectious disease and neurosurgical advice, is always called for.

Actinomyces israelii and Fusobacterium nucleatum brain abscess in an immunocompetent patient: case report.

Introduction: Brain abscess is the most common focal infectious neurological injury. Until the nineteenth century this condition was fatal, however the development of neuroimaging for early diagnosis, neurosurgery and antibiotic therapy in the twentieth century has led to new therapeutic strategies decreasing mortality from 50 % in the 1970s to less than 10 % nowadays. In this context we report a case of brain abscess with a dental origin. Case report: A immunocompetent man without any addiction presented to the emergency department with dysarthria and frontal headache at home. The clinical examination was normal. Further investigations revealed a polymicrobial brain abscess as a consequence of an ear, nose or throat (ENT) infection with locoregional extension with a dental starting point involving Actinomyces israelii and Fusobacterium nucleatum . In spite of a rapid diagnosis and a neurosurgical management associated with an optimal treatment by a dual therapy made of ceftriaxone and metronidazole the patient unfortunately died. Conclusion: This case report shows that despite a low incidence and a good prognosis following the diagnosis, brain abscesses can lead to patient's death. Thereby, when the patient's condition and urgency allow, a thorough dental examination of patients with neurological signs following the recommendations would improve the diagnosis made by the clinician. The use of microbiological documentation, the respect of pre-analytical conditions, the interaction between the laboratory and the clinicians are indispensable for an optimal management of these pathologies.

Acute Otitis Media with Intracranial and Intratemporal Complications: A Case Study.

Acute otitis media continues to be one of the most common infections today and a major cause of the prescription of antibiotics in the pediatric age group. Complications of this condition are rare, especially when antibiotic therapy is started early; however, complications related to acute otitis media cause dramatic morbidity. This report provides a review related to a case of acute otitis media with bilateral intracranial and intratemporal complications.

Brain abscesses caused by anaerobic microorganisms: a systematic review

The objective of this study was to perform a systematic review of the characteristics, causative microorganisms and outcome of brain abscesses caused by anaerobic bacteria over the past 25 years. We reviewed studies on brain abscesses which included infection due to anaerobic microorganisms published between 1998 and 2022. We excluded reports with polymicrobial infections (more than 2 anaerobic bacteria isolated) and those that do not provide enough information to make comparisons, the reports with only one case of brain abscess due to anaerobes, as well as those focused on an only anaerobic bacterium. Also, we have excluded the cases in pediatric population. We searched the scientific literature through the Cochrane Library, EMBASE and PubMed/MEDLINE databases for studies of this condition. We finally included 28 studies with 6,167 patients, of which 715 (11.5%) were cases caused by anaerobic bacteria. There was a male predominance (70%) and mean age of 40.3 years. Most infections were monomicrobial (59.4%). The most common anaerobic microorganisms isolated were Bacteroides spp (43.4%) and Gram-positive anaerobic cocci (35.1%). Cases of brain abscesses caused by anaerobic bacteria were most frequent in Asia and Europe. The source of infection most frequent was otogenic in 84.6% followed by a neurosurgery procedure infection in 23% of patients. The main symptom observed was headache in 95.6% of patients followed by fever (69.5%). Surgical treatment was performed in 48 % of patients and the percentage of patients in whom antibiotic treatment was applied range 88.8% to 100%. The main limitation of this review is the non-inclusion of studies published before of 1998 in which MALDI-TOF MS system had not been introduced in the majority of laboratories for routine identification. (AU)

El objetivo de este estudio fue realizar una revisión sistemática de las características, los microorganismos causantes y evolución de los abscesos cerebrales causados por bacterias anaerobias en los últimos 25 años. Revisamos los estudios sobre abscesos cerebrales que incluyeron infección por microorganismos anaerobios publicados entre 1998 y 2022. Se excluyeron estudios con infecciones polimicrobianas (más de 2 bacterias anaerobias aisladas) y aquellos que no proporcionaban suficiente información para realizar comparaciones, los estudios con solo un caso de absceso por anaerobios así como aquellos focalizados solo en una bacteria anaerobia. También se excluyeron los casos en población pediátrica. Se realizó búsqueda de la literatura científica a través de la librería Cochrane y base de datos EMBASE y PubMed/MEDLINE para estudios con esas características. Se incluyeron finalmente 28 estudios con 6167 pacientes, de los cuales 715 (11,5%) fueron casos causados por bacterias anaerobias. Hubo predominio masculino (70%) y edad media de 40,3 años. La mayoría de las infecciones fueron monomicrobianas (59,4%). Los microorganismos anaerobios más comunes aislados fueron Bacteroides spp (43,4%) y cocos anaerobios grampositivos (35,1%). Los casos de abscesos cerebrales causados por bacterias anaerobias fueron más frecuentes en Asia y Europa. La fuente de infección más frecuente fue la otogénica en un 84,6% seguida de una infección por procedimiento de neurocirugía en un 23% de los pacientes. El principal síntoma observado fue la cefalea en el 95,6% de los pacientes seguido de fiebre (69,5%). Se realizó tratamiento quirúrgico en el 48 % de los pacientes y el porcentaje de pacientes en los que se aplicó tratamiento antibiótico oscila entre el 88,8 % y el 100 %. La principal limitación de esta revisión fue la no inclusión de estudios anteriores a 1998 en los que todavía no se había introducido MALDI-TOF MS en la mayoría de los laboratorios para el diagnóstico rutinario. (AU)

Hemophilus Septicemia Meningitis in an 11-Month-Old Vaccinated Infant.

Haemophilus influenzae is a gram-negative pleomorphic coccobacillus associated with many diseases, such as meningitis, pneumonia, septicemia, cellulitis, and otitis media. The most virulent and most common serotype is H. influenzae type b (Hib), which was responsible for the majority of meningitis cases until the development of vaccines that led to a decrease in its incidence worldwide. Here, we report the case of an 11-month-old female infant who was previously healthy and fully vaccinated against Hib and developed sepsis and meningitis. The patient was managed as a case of partially treated bacterial meningitis but failed to respond to a short-duration course of antibiotics and had focal seizures of the left hand. Non-contrast brain MRI revealed multiple and bilateral brain abscesses more evident on the left side. The patient was then followed up with imaging every 10-14 days to monitor the response and resolution of the brain abscesses. She was successfully treated with a full course of intravenous ceftriaxone for six weeks until imaging was clear and the brain abscesses were nearly undetected. Invasive H. influenzae infections are considered emerging cases, and there is a need to consider and suspect the disease even in fully vaccinated patients.

Brain abscesses caused by anaerobic microorganisms: a systematic review.

The objective of this study was to perform a systematic review of the characteristics, causative microorganisms and outcome of brain abscesses caused by anaerobic bacteria over the past 25 years. We reviewed studies on brain abscesses which included infection due to anaerobic microorganisms published between 1998 and 2022. We excluded reports with polymicrobial infections (more than 2 anaerobic bacteria isolated) and those that do not provide enough information to make comparisons, the reports with only one case of brain abscess due to anaerobes, as well as those focused on an only anaerobic bacterium. Also, we have excluded the cases in pediatric population. We searched the scientific literature through the Cochrane Library, EMBASE and PubMed/MEDLINE databases for studies of this condition. We finally included 28 studies with 6,167 patients, of which 715 (11.5%) were cases caused by anaerobic bacteria. There was a male predominance (70%) and mean age of 40.3 years. Most infections were monomicrobial (59.4%). The most common anaerobic microorganisms isolated were Bacteroides spp (43.4%) and Gram-positive anaerobic cocci (35.1%). Cases of brain abscesses caused by anaerobic bacteria were most frequent in Asia and Europe. The source of infection most frequent was otogenic in 84.6% followed by a neurosurgery procedure infection in 23% of patients. The main symptom observed was headache in 95.6% of patients followed by fever (69.5%). Surgical treatment was performed in 48 % of patients and the percentage of patients in whom antibiotic treatment was applied range 88.8% to 100%. The main limitation of this review is the non-inclusion of studies published before of 1998 in which MALDI-TOF MS system had not been introduced in the majority of laboratories for routine identification. The patient rate with isolation of anaerobic bacteria in brain abscesses is low, but these data could be underestimated mainly due to the fastidious nature of these microorganisms and the difficulties in the identification of some anaerobes.

A case report of brain abscess caused by carbapenem-resistant Klebsiella pneumoniae

ABSTRACT The treatment of infections caused by carbapenem-resistant Klebsiella pneumoniae (CR-Kp) strains is difficult due to the limited antimicrobial options and high mortality. There are many reports on intracranial infections caused by CR-Kp, but only a few on brain abscesses caused by CR-Kp. Here, we present a case of brain abscess caused by CR-Kp successfully treated with combined antibiotics. A 26-year-old male patient was admitted to our hospital due to high fever and headache. His past medical history includes a surgical intervention due to an acute subdural hematoma, performed at an external healthcare center. After the current diagnosis of cerebral abscess, he underwent two surgeries. During the procedure, multiple cerebral abscesses were drained and capsulotomies were performed under ultrasound guidance. The combination of meropenem and vancomycin was started. The contents of the abscesses were sent to the microbiology and pathology laboratory. On the 3 rd day of treatment, the medical team was informed that CR-Kp grew in an abscess culture. The patient's treatment was changed to meropenem + colistin + tigecycline. The patient developed electrolyte disturbances during the follow-up and this was considered an adverse effect of colistin. On the 41 st day of treatment, colistin was discontinued, fosfomycin was added, and meropenem and tigecycline were maintained. Treatment was discontinued on the 68 th day, when the patient was discharged. The general condition of the patient, who has been followed up for two years, is satisfactory. The treatment of CR-Kp infections should be individualized, and the pharmacokinetics and pharmacodynamics of antibiotics should be considered in each case.

Retrospective review of the epidemiology, microbiology, management and outcomes of intra-cranial abscesses at a neurosurgical tertiary referral centre, 2018-2020.

BACKGROUND: Intracranial abscesses are rare but serious, and are associated with significant morbidity and mortality. Due to both the rarity and severity of these infections, well-controlled trials have not been reported in the literature, and optimal management is a matter for expert opinion. Advances in surgical management have improved outcomes and increased rates of microbiological diagnosis. However, the approach to antimicrobial chemotherapy varies considerably, including the choice of antibiotic, the duration of treatment, and the timing of oral switch. METHODS: We conducted a retrospective review of 43 cases of intracranial abscesses from a large, tertiary neurosurgical centre in London, UK, between 2018 and 2020, including 29 primary intra-parenchymal abscesses, 11 subdural abscesses and 3 extradural abscesses. RESULTS: The majority of cases had surgical intervention; 6/43 (14%) required repeat intervention (all intra-parenchymal abscesses). A microbiological diagnosis was made in 83% of cases. Intravenous antibiotics were given for a median of 33 days (IQR 23-44 days), with a variable duration of oral follow-on antibiotics. Total duration of antibiotic treatment ranged from 0 to 467 days. Only three patients from our cohort are known to have died. CONCLUSION: Shorter courses of intravenous antibiotics for brain abscesses were not associated with increased mortality. In the absence of well-controlled trials, a national registry of intracranial abscesses would provide invaluable data to inform optimal treatment.

Case Report: Clinical characteristics and genetic analysis of two patients with hereditary hemorrhagic telangiectasia.

Objective: To analyze the clinical features and genetic characteristics of two patients with hereditary hemorrhagic telangiectasia (HHT) and to review the relevant literature. Methods: The clinical data of two HHT patients admitted to the author's hospital between April 2019 and February 2022 were retrospectively analyzed. Meanwhile, the genetic analysis was performed with their consent. Results: The first patient was a 62-year-old woman who had been complaining of shortness of breath and fever for 20 days. Her previous medical history included brain abscess drainage and video-assisted thoracoscopic surgery for a pulmonary hemangioma. A right heart catheterization revealed no pulmonary arterial hypertension, and an abdominal enhanced magnetic resonance imaging revealed multiple arteriovenous malformations in the liver. Her ACVRL1 heterozygous variants were discovered through whole-exon gene testing. The second case involved a 47-year-old woman who had been experiencing chest tightness for the past 2 years. Several years ago, she underwent brain abscess drainage and embolization of a pulmonary arteriovenous fistula. Ultrasound revealed generalized hepatic vascular dilation, and enhanced computed tomography revealed numerous pulmonary venous fistulas scattered in both lungs as well as multiple arteriovenous malformations in the liver. Her whole-exon gene testing revealed that she, like her son, had heterozygous ENG variants. Conclusion: HHT patients may experience infection, bleeding, dyspnea, and other symptoms. Imaging is important in disease diagnosis and management because early detection and treatment can prevent major complications and disability or even death.

Multifocal brain abscesses caused by invasive Streptococcus intermedia: A case report.

Multifocal brain abscesses caused by invasive Streptococcus intermedia are relatively rare. Here, we present a 67-year-old male was admitted to the hospital for unconsciousness and fever. The computed tomography (CT) examination showed multiple intracranial space-occupying and "cavity-like" changes in the right lower lung. The examination of cerebrospinal fluid (CSF) was consistent with typical bacterial meningitis, CSF analyses revealed leukocytosis (10,300 × 106/L), elevated protein levels (140.39 mg/dL), decreased glucose levels (0.27 mmol/L), and normal chloride concentration level (120.2 mmol/L), however, pathogens were not detected in the cultures. Then, the CSF and sputum samples were analyzed using meta-genomic next-generation sequencing (mNGS), and S. intermedia was detected in both samples. We adjusted the use of antibiotics according to the results of mNGS in time. After anti-infective treatment, the patient achieved good treatment results in a very short time. This case highlights the mNGS can identify pathogens of brain abscess, and provide strong evidence for clinical diagnosis and treatment strategy.

Brain abscesses caused by anaerobic bacteria.

OBJECTIVES: The objective of this study was to review the characteristics, causative bacteria, treatment and outcomes of brain abscesses due to anaerobes in our health setting. METHODS: A retrospective analysis of all brain abscesses caused by anaerobic bacteria over the period 2005-2021 was performed. RESULTS: Out of 300 brain abscesses identified during the study period, 31 were produced by anaerobic pathogens, either alone (monomicrobial infection) or together with aerobic and/or anaerobic bacteria (polymicrobial infection). The mean age of the 31 patients was 53 years, and 61.2% were male; 51.6% of infections were polymicrobial, with only four (12.9%) caused by anaerobic bacteria alone. Forty-three anaerobic bacteria were isolated: Cutibacterium acnes in thirteen (41.9%), Parvimonas micra in eight (25.8%), and Prevotella spp. in seven (22.5%). The most frequent etiologies were local neurosurgery (13/41.9%) and contiguous otogenic, oral, or sinus foci of infection (8/28.8%). Cancer was present in eight patients (28.8%), headaches in seventeen (54.8%), and fever in nine (28.8%). All patients received both surgery and antimicrobial therapy. The abscess was in the frontal region in 12 patients (38.7%) and in the parietal region in 11 (35.4%). A good outcome was obtained in all patients. CONCLUSIONS: Anaerobes were isolated in 10.3% of patients with brain abscesses in our health setting, similar to other reports. C. acnes was the most frequently detected anaerobe, especially in neurosurgical patients.

Multiple brain abscesses in an extremely preterm infant and a 12-year follow up: a case report.

BACKGROUND: Brain abscesses are uncommon but life-threatening in extremely preterm (EP, Gestational Age < 28 weeks) infants. The information of long-time follow-up is rare, but very few cases presented almost intact neural function after injury. CASE PRESENTATION: We report the clinical course and the outcome of a 27-week preterm infant with multiple brain abscesses. The brain abscesses were detected by cranial magnetic resonance imaging (MRI) and were treated with surgical aspiration twice and a 7-week course of intravenous antibiotics. The patient had two episodes of seizure like activities at 8 and 11 years old respectively, whereas she had normal results of electroencephalogram (EEG). MRI showed encephalomalacia and periventricular leukomalacia. Otherwise, she had no obvious neurological deficits based on multiple physical examination and her intellectual quotient (IQ) was in normal range in the long-time follow-up. CONCLUSIONS: Early diagnosis of brain abscesses and appropriate therapy can improve the prognosis. Furthermore, this case report provides an example of the possible neuroplasticity of brain in EP infants.

A rare case of multiple brain abscesses caused by apical periodontitis of deciduous teeth in congenital heart disease: a case report.

BACKGROUND: A brain abscess is a focal infection in which abscesses form in the brain. A brain abscess is a rare but fatal disease when rupture occurs into the ventricles. We report a case of multiple brain abscesses caused by a hematogenous infection from the apical periodontitis of deciduous teeth. CASE PRESENTATION: The patient was a 7-years and 8-months-old male with congenital heart disease. The patient sought medical attention due to fever and headache, for which he was started on three antibiotics with a diagnosis of multiple brain abscesses. Given that apical periodontitis of deciduous teeth was strongly suspected as the source of the brain abscess, the deciduous teeth were extracted. Immediately after deciduous teeth extraction, the patient's headache and neurological symptoms disappeared. CONCLUSIONS: After teeth extraction, a clear shrinkage of the brain abscess was observed, and the patient was discharged from the hospital.

Surgical strategy for tuberculous brain abscess with dural infiltration: A case report.

BACKGROUND: Tuberculosis is one of the top 10 leading causes of death worldwide. Although tuberculous central complications account for 1% of all tuberculosis patients, there are many cases of medical resistance; and early surgical treatment is required for brain abscess. Reports on tuberculous brain abscesses with dural infiltration are rare, and there are no reports on surgical treatment methods. CASE DESCRIPTION: An 81-year-old man was presented with the right arm paresis. His recent medical history included a 6-month course of immunosuppressants, and steroids prescribed for ulcerative colitis, and four antituberculosis drugs had been started 2 months before for relapse of pulmonary tuberculosis at an early age. Head T1-weighted magnetic resonance imaging with administration of gadolinium showed two ring-enhanced lesions in the left precentral gyrus and continuous with the dura mater. Surgery was performed and he was pathologically diagnosed with a tuberculous brain abscess. Since the pathological diagnosis revealed dura mater invasion, we removed the dura mater and reconstructed by periosteum. After the surgery, the symptoms gradually improved, and the abscess and edema improved when viewed on the image. Despite the administration of steroids for ulcerative colitis without antituberculosis drugs, no recurrence was observed for 1 year. Recurrence of tuberculous brain abscess is a major problem in immunosuppressed patients, but it is considered that the relapse could be prevented by removing the dural infiltration. CONCLUSION: In cases of tuberculous brain abscess with dural infiltration, it is considered that the recurrence can be prevented even in an immunosuppressed state by removing the dura.

Multifocal Brain Abscesses Due to Streptococcus intermedius.

Brain abscess is a life-threatening illness that occurs when an intracerebral infection leads to cerebritis and subsequent pus formation within a well-vascularized capsule. While streptococci (aerobic, anaerobic, and microaerophilic) are the most common bacteria isolated, its presentation as multifocal brain abscesses is rarely described. In this report, we describe a 43-year-old male patient who presented to the emergency department due to progressive lethargy and low-grade fever of seven days worsening. Upon further evaluation, the patient was found to have multiple brain abscesses secondary to Streptococcus intermedius, confirmed by the culture of stereotactic aspiration of brain collection. This case underlines the importance of considering Streptococcus intermedius as a cause of multifocal brain abscesses.