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Published on: July 24, 2016
Unusual presentation of brain abscess in a 23-month-old infant
Qingyong Xiang1, Chonggui Jiang2, Jiangzhi Wen1
1Department of Neurosurgery, Aba Tibetan and Qiang Autonomous Prefecture People's Hospital, barkam, China.
Insights
This study reports a rare case of infant brain abscess without typical causes, potentially linked to diarrhea. Successful treatment involved surgery and antibiotics, with a good long-term outcome.
Area of Science:
- Pediatric Neurology
- Infectious Diseases
- Radiology
Background:
- Pediatric brain abscesses often stem from predisposing factors like ENT infections or trauma.
- Cryptogenic cases, lacking clear causes, represent a subset of these infections.
Observation:
- An infant presented with multiple, multiloculated brain abscesses.
- The infant exhibited apathy and diarrhea, with no history of common predisposing conditions.
- Diffusion-weighted imaging (DWI)-MRI suggested a hematogenous spread, with diarrhea as a potential trigger.
Findings:
- Successful treatment was achieved through surgical excision and an 8-week course of intravenous antibiotics.
- The infant showed complete physical and mental recovery at 1-year follow-up.
- Blood C-reactive protein trends may help predict treatment efficacy.
Implications:
- Highlights unusual presentations of pediatric brain abscesses.
- Suggests diarrhea as a potential, albeit rare, precipitating factor in cryptogenic brain abscesses.
- Emphasizes the importance of monitoring inflammatory markers for treatment guidance.
Backgroud:
Pediatric brain abscesses usually occur as a consequence of predisposing conditions, such as ENT (ear, nose, and throat) infection and physical damage. But there are still a number of cryptogenic infection cases.
Methods:
We present an unusual cryptogenic infection case of multiple and multiloculated brain abscess in an infant, which was in the absence of ENT infection, meningitis, trauma, prior surgery, cyanotic heart disease, or immune defect. The child has no specific symptoms but keeping apathic and days of diarrhea. Deduced from clinical presentation and this case's DWI-MRI features, the onset of infection is hematogenous route, and the diarrhea could be the possible inducement. The child was successfully treated by surgical excision of big lesions and an 8-week total course of intravenous antibiotics. At the end of the 1-year follow-up period, the infant is well at both of physical and mental health.
Conclusion:
The interest of this case is the silent clinical presentation and the possibly rare precipitating factor. To a certain extent, the variation trend of blood C-reactive protein level could predict the clinical effect of antibiotics in brain abscess case.
