Background
Brain abscesses are the rare and most severe form of actinomycosis, which usually manifests as abscesses of the occipital or parietal lobe due to direct expansion from an adjacent area, the oral cavity. In the medical literature, there are only a few reported cases of brain abscess caused by Actinomyces meyeri. In this report, we present a 35-year-old male patient who experienced an insidious headache and left-sided weakness and was diagnosed with an Actinomyces meyeri brain abscess.
Case presentation
A 35-year-old Nepalese man came to our institute with the primary complaint of insidious onset of headache and left-sided weakness. His physical examination was remarkable for the left-sided weakness with power 2/5 on both upper and lower limbs, hypertonia, hyperreflexia and positive Babinski sign, with intact sensory function. Cardiac examination revealed systolic murmur with regular S1 and S2, and lung examination was normal. The patient had poor dental hygiene. Biochemistry and haematology panel were normal. Urinalysis, chest X-ray and electrocardiogram revealed no abnormality. A transthoracic echocardiogram revealed mitral regurgitation. However, there was no evidence of valvular vegetation. A magnetic resonance imaging (MRI) of the brain was performed, which showed a bi-lobed rim enhancing lesion with a conglomeration of two adjoining round lesions in the right parietal parasagittal region. Perilesional oedema resulting in mass effect over the right lateral ventricle and mid-right uncal herniation with midline shift was noted. Craniotomy was performed, and the lesion was excised. Gram staining of the extracted sample revealed gram variable filamentous rods. Creamy white, moist, confluent colonies were observed after performing anaerobic culture in chocolate agar. On the gram staining, they showed gram-positive filamentous rods. Actinomyces meyeri was identified based on matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) technology. Based on the susceptibilities, he was successfully treated with ampicillin-sulbactam.
Conclusions
In conclusion, Actinomyces should be considered in the differential diagnosis of brain abscess in patients with poor dental hygiene, and early diagnosis and appropriate treatment can lead to better results.
Campylobacter is a gram negative bacterium that exhibits tissue tropism. We report a case of Campylobacter fetus bacteremia associated with infra-renal abdominal aortitis. The patient was a poor surgical candidate so she was initially treated only medically. Her course was complicated by the development of a pseudoaneurysm. An endovascular stent was placed and the patient was given 4 more weeks of antibiotics. The patient continues to do well several months after stent placement. This case illustrates the success of medical treatment combined with stent placement in a patient who could not undergo surgery for an infected abdominal aortic pseudoaneurysm.
A 24-year-old Caucasian woman with a history of intravenous drug abuse and multiple hospital admissions for substance abuse related medical problems presented with pneumonia and was discharged home on oral antibiotics. Three days later, her blood culture grew acid fast bacilli, which was subsequently identified as M. abscessus subspecies abscessus. Transthoracic and transesophageal echocardiogram (TTE and TEE respectively) was suggestive of tricuspid valve (TV) endocarditis. CT scan of the chest showed evidence of septic pulmonary emboli, pneumonic consolidation and pleural effusion requiring chest tube placement. BAL and blood cultures grew Mycobacterium abscessus while pleural fluid cultures remained sterile. She was treated with a combination antibiotic therapy and completed a six-week course with resolution of her symptoms and microbiological cure. We present this rare case of M. abscessus native tricuspid valve endocarditis associated with lung infection treated with a short course of combination antibiotic therapy.
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