Intracerebral Abscess Caused by Actinomyces israelii

We describe a case of 49-years old female with a medical history of penicillin allergy, who suffered from brain infection caused by Actinomyces israelii. Therefore, the available therapy was metronidazole, ceftriaxone, and chloramphenicol. Due to a deterioration of the general and neurological condition of the patient, it was decided to perform a scratch skin test on penicillin, which was negative. After that, penicillin was administrated parenterally. The patient showed no hypersensitive reaction. Improvement was achieved. The patient underwent three subsequent surgeries due to primary and recurrent brain abscesses. There was a distinct improvement in her clinical status. Two months after the second re-surgery, the control computed tomography showed complete regression of the abscess. Brain abscess caused by an Actinomycess israelii is very resistant to medication. However, surgical evacuation significantly accelerates the healing process. A good medication therapy is crucial and in most cases the drug of choice is penicillin. We emphasize the importance of a combined approach for treating this unusual brain infection.