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Missed epidural brain abscess after furunculosis

Bruce M Lo1, Eleanor A Erwin

  • 1Department of Emergency Medicine, Eastern Virginia Medical School, Norfolk, VA 23507, USA. brucelo1@yahoo.com

The American Journal of Emergency Medicine
|April 16, 2008
PubMed

Insights

Community-associated methicillin-resistant Staphylococcus aureus (ca-MRSA) causes skin infections and can lead to invasive conditions. A case highlights the importance of considering ca-MRSA in invasive infections, even in brain abscesses, to ensure timely diagnosis and treatment.

Area of Science:

  • Infectious Diseases
  • Microbiology
  • Neurology

Background:

  • Community-associated methicillin-resistant Staphylococcus aureus (ca-MRSA) is a significant pathogen.
  • ca-MRSA is frequently associated with cutaneous skin infections.
  • Invasive infections, including endocarditis, pneumonia, and necrotizing fasciitis, have been linked to ca-MRSA.

Observation:

  • A case of a missed epidural brain abscess caused by ca-MRSA is presented.
  • The patient had a recent history of furunculosis.
  • A lumbar puncture was performed for meningitis workup prior to a head CT scan.

Findings:

  • The case underscores the potential for ca-MRSA to cause serious invasive infections beyond skin.
  • Delayed diagnosis of the brain abscess due to missed ca-MRSA was a critical issue.
  • The diagnostic pathway highlights potential pitfalls in invasive infection workups.

Implications:

  • Physicians must maintain a high index of suspicion for ca-MRSA in invasive infections.
  • Prompt head imaging is crucial in patients with suspected central nervous system involvement and risk factors for ca-MRSA.
  • Early consideration of ca-MRSA can prevent severe complications and improve patient outcomes.

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