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Cerebral manifestation of an actinomycosis infection. A case report
M Winking1, W Deinsberger, C Schindler
1Neurosurgical Clinic, Justus-Liebig University Giessen, Germany.
Abstract:
Affection of the CNS by actinomycosis is a rare but treatable manifestation of an infection with actinomyces israeli. Neurological involvement includes a meningeal, granulomatous and also pseudotumoral form. We report the case of a patient suffering from an intracerebral actinomycosis abscess. The source of infection was the upper jaw. After a right frontal craniotomy the intracerebral abscess was removed. Postoperatively the patient received initially a combined antiedemateous and antibiotic therapy with 12 mg dexamethasone and 6 g cefotaxime and 3 g amoxicilline. After 4 weeks of treatment with improving neurological deficits dexamthasone therapy was reduced followed by an exclusive antibiotic therapy for another 4 weeks. During this time the patient recovered completely.
Insights
Central nervous system (CNS) actinomycosis, though rare, is treatable. This case highlights successful surgical removal and antibiotic treatment of an intracerebral abscess caused by Actinomyces israelii.
Area of Science:
- Neurology
- Infectious Diseases
- Neurosurgery
Background:
- Actinomycosis is a rare bacterial infection caused by Actinomyces species.
- Central nervous system (CNS) involvement is an uncommon but serious manifestation.
- Intracerebral abscesses due to actinomycosis require prompt diagnosis and management.
Observation:
- A patient presented with an intracerebral abscess.
- The presumed source of infection was the oral cavity (upper jaw).
- Neurological deficits were present due to the abscess.
Findings:
- Surgical excision of the intracerebral abscess was performed via right frontal craniotomy.
- Postoperative treatment included combined dexamethasone and antibiotics (cefotaxime, amoxicillin).
- Successful recovery was achieved after a course of antibiotics and gradual reduction of dexamethasone.
Implications:
- This case underscores the importance of considering actinomycosis in the differential diagnosis of brain abscesses.
- Aggressive surgical and antibiotic management can lead to complete recovery.
- Early source control and appropriate antimicrobial therapy are crucial for favorable outcomes in CNS actinomycosis.