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Brain abscess with Ureaplasma parvum in a patient with granulomatosis with polyangiitis
Marie Madlener1, Marianne Breuninger2, Arne Meißner3
1Department of Neurology, Faculty of Medicine, University of Cologne, University Hospital Cologne, Kerpener Straße 62, 50937, Cologne, Germany. marie.madlener@uk-koeln.de.
Purpose:
Ureaplasma species are associated with urogenital infections, infertility and adverse pregnancy outcomes as well as neonatal infections. Involvement of the central nervous system in adults is extremely rare. We report an unusual case of a brain abscess secondary to otitis media with Ureaplasma parvum in a patient with granulomatosis with polyangiitis (GPA).
Methods:
Imaging and laboratory findings, treatment decisions, and outcome of this case are explicated.
Results:
A young adult with GPA presented with progredient earache after ambulant diagnosis of otitis media. Despite different courses of broad-spectrum antibiotic therapy, she developed meningoencephalitis due to mastoiditis following temporal abscess formation. Mastoidectomy and neurosurgical abscess removal were performed. Standard cultures of cerebrospinal fluid, blood and intracranial abscess material, as well as polymerase chain reaction (PCR) for common bacterial and viral meningitis pathogens remained negative. Only eubacterial PCR of intracranial abscess material returned positive for Ureaplasma parvum. The patient finally improved under antibiotic therapy with moxifloxacin and doxycycline.
Conclusion:
Ureaplasma species are rare causative pathogens in immunocompromised patients. They should be considered in patients with humoral immunodeficiencies with culture-negative infections failing standard therapy. Eubacterial PCR should be performed in early states of infection in these patients for immediate diagnosis and initiation of appropriate treatment to prevent adverse outcomes.
Insights
Ureaplasma parvum caused a rare brain abscess in an immunocompromised patient with granulomatosis with polyangiitis (GPA). Early eubacterial PCR is crucial for diagnosing such culture-negative infections.
Area of Science:
- Neurology
- Infectious Diseases
- Immunology
Background:
- Ureaplasma species are linked to urogenital infections and adverse pregnancy outcomes.
- Central nervous system involvement by Ureaplasma in adults is exceptionally rare.
- Granulomatosis with polyangiitis (GPA) is a rare autoimmune disease affecting blood vessels.
Observation:
- A young adult with GPA presented with worsening earache and otitis media.
- Despite broad-spectrum antibiotics, she developed meningoencephalitis secondary to a temporal brain abscess and mastoiditis.
- Standard cultures were negative, but eubacterial PCR identified Ureaplasma parvum in the abscess.
Findings:
- Ureaplasma parvum was identified as the causative agent of a brain abscess in an immunocompromised patient.
- The patient improved with moxifloxacin and doxycycline therapy after neurosurgery.
- This case highlights an unusual CNS manifestation of Ureaplasma infection.
Implications:
- Ureaplasma should be considered in immunocompromised patients with culture-negative infections, especially those with humoral immunodeficiencies.
- Eubacterial PCR is recommended for early diagnosis of Ureaplasma in complex infections.
- Prompt diagnosis and targeted therapy are essential to prevent severe outcomes in such cases.
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