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Streptococcus intermedius cerebellar abscess as first presentation of sarcoidosis: a case report

Abdulrahman Al-Ahmadi1, Anatoli Pinchuk1, Klaus-Peter Stein1

  • 1Department of Neurosurgery, Otto Von Guericke University, Magdeburg, Germany.

Journal of Medical Case Reports
|May 24, 2026
PubMed
Abstract

Insights

This case report details a rare instance of a cerebellar abscess caused by Streptococcus intermedius, which was the first sign of sarcoidosis in an immunocompromised patient. Prompt diagnosis and multidisciplinary treatment led to a full recovery.

Area of Science:

  • Neurology
  • Infectious Diseases
  • Immunology

Background:

  • Cerebellar abscesses are rare, life-threatening infections requiring prompt management.
  • Streptococcus intermedius is a known cause of brain abscesses, especially in immunocompromised individuals.
  • Sarcoidosis can predispose patients to opportunistic infections due to immune dysregulation.

Purpose of the Study:

  • To report the first case of a cerebellar abscess caused by S. intermedius as the initial manifestation of sarcoidosis.
  • To highlight the importance of considering underlying immunological conditions in patients with atypical infections.

Main Methods:

  • A 45-year-old male presented with symptoms of a cerebellar abscess.
  • Neuroimaging confirmed the abscess, leading to surgical evacuation and microbiological analysis.
  • Diagnosis of sarcoidosis was established via bronchial biopsy and immunological evaluation.

Main Results:

  • S. intermedius was identified as the causative agent of the cerebellar abscess.
  • The patient was diagnosed with sarcoidosis, presenting with pulmonary infiltrates and T-cell lymphocytopenia.
  • Successful treatment with antibiotics and surgical intervention resulted in complete abscess resolution and neurological recovery.

Conclusions:

  • This case represents an unusual initial presentation of sarcoidosis.
  • Clinicians should suspect underlying immunological disorders in patients with severe or atypical infections.
  • Multidisciplinary management is crucial for favorable outcomes in complex cases.
Keywords:
Streptococcus intermediusCase reportCentral nervous system infectionCerebellar abscessImmunosuppressionSarcoidosis

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