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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.
Summary
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.