Multi-antibiotic resistant brain abscess sensitive only to chloramphenicol: a case report

A brain abscess is a focal, intracerebral infection that begins as a localized area of cerebritis and develops into a collection of pus surrounded by a well-vascularized capsule.

An 18 year old male was diagnosed to have culture-negative bilateral subdural empyema, which was drained and the patient was discharged, only to return 3 months later with a left temporo-parietal abscess that was drained and continued to show no growth on cultures and was non-responsive to multiple antibiotics. As a final effort, chloramphenicol therapy was begun and the patient showed immediate improvement and made a relatively uneventful recovery.

Chloramphenicol is an antimicrobial agent used rarely today in the United States because of its associated adverse effects. But the fact remains, that it is a broad-spectrum agent that is highly effective against many gram-positive and gram-negative bacteria, spirochetes, chlamydiae, and rickettsia. Due to its ability to achieve high concentrations in the cerebrospinal fluid we would advise it as second line therapy for culture negative brain abscesses.