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[A case of brain abscess associated with enterococcal endocarditis]
H Mashimoto1, S Maesaki, J Araki
1Department of Internal Medicine, Sasebo City General Hospital.
Abstract:
Enterococcal infections involving the central nervous system are uncommon clinical entities. A 74-year-old male was admitted to our hospital on November 3, 1991 for high fever. Nuchal rigidity was observed at neurological examination. All four blood cultures yielded E. faecalis. The MIC value of ABPC against the isolated E. faecalis was 0.25 microgram/ml. Vegetation on the mitral valve and mitral regurgitation were revealed by an echocardiogram. Enhanced CT scan showed low density area with ring enhancement in the right basal ganglia and a CSF examination suggested bacterial meningitis. He became better after ABPC 8 g/day was intravenously administered. Then the vegetation on the mitral valve and the brain abscess disappeared. He was discharged with no complications. We reported a rare case of brain abscess associated with enterococcal endocarditis.
Insights
This case report details a rare instance of Enterococcus faecalis brain abscess in a patient with endocarditis. Prompt treatment with ampicillin (ABPC) successfully resolved both the infection and abscess.
Area of Science:
- Neurology
- Infectious Diseases
- Cardiology
Background:
- Enterococcal infections of the central nervous system (CNS) are rare.
- Enterococcus faecalis (E. faecalis) can cause serious infections, including endocarditis and CNS complications.
Observation:
- A 74-year-old male presented with fever and nuchal rigidity.
- Blood cultures identified E. faecalis with a low ampicillin (ABPC) Minimum Inhibitory Concentration (MIC) of 0.25 µg/ml.
- Echocardiogram revealed mitral valve vegetation and regurgitation; CT scan showed a right basal ganglia abscess; CSF analysis indicated bacterial meningitis.
Findings:
- Intravenous administration of ABPC at 8 g/day led to clinical improvement.
- Resolution of mitral valve vegetation and brain abscess was confirmed.
- The patient was discharged without complications.
Implications:
- This case highlights the importance of considering enterococcal endocarditis in patients with CNS infections.
- Early diagnosis and appropriate antibiotic therapy, such as ampicillin for susceptible strains, are crucial for favorable outcomes.
- Successful treatment of CNS complications associated with enterococcal endocarditis is achievable.