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Pontine abscess with initial treatment failure following infectious endocarditis with Streptococcus salivarius

Fredrikke Christie Knudtzen1, Maja Lynge2, Shahin Gaini1

  • 1Department of Infectious Diseases, Odense University Hospital, Odense C, Denmark.

BMJ Case Reports
|July 4, 2015
PubMed

Insights

A brain abscess caused by Streptococcus salivarius, a rare complication of endocarditis, was successfully treated with prolonged antibiotic therapy. This case highlights the importance of sustained treatment for pontine abscesses, even after initial recovery.

Area of Science:

  • Infectious Diseases
  • Neurology
  • Cardiology

Background:

  • Brain abscesses are serious intracranial infections.
  • Pontine abscesses are particularly rare and challenging to treat.
  • Streptococcus salivarius is a common cause of infective endocarditis.

Observation:

  • A 65-year-old man presented with symptoms suggestive of meningitis, including headache, fever, and diplopia.
  • Cerebral MRI revealed a 17x30 mm pontine abscess with surrounding edema.
  • The patient had a history of Streptococcus salivarius aortic valve endocarditis two months prior.

Findings:

  • The pontine abscess was not amenable to surgical intervention.
  • Initial 4-week multidrug antibiotic treatment led to clinical improvement.
  • Recurrence of symptoms and abscess progression occurred after treatment cessation.
  • A prolonged course of broad-spectrum antibiotics followed by oral pivampicillin resulted in abscess regression to 7.5 mm.

Implications:

  • This case underscores the efficacy of prolonged antibiotic therapy in managing pontine abscesses.
  • It emphasizes the need for careful monitoring and extended treatment protocols for central nervous system infections secondary to endocarditis.
  • The successful management highlights a non-surgical approach for selected cases of pontine abscesses.

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