Esophageal Squamous Cell Carcinoma Presenting with Streptococcus intermedius Cerebral Abscess

Abstract

Background Cerebral abscess is caused by inoculation of an organism into the brain parenchyma from a site distant from the central nervous system. Streptococcus intermedius (S. intermedius) is a commensal organism that is normally present in the aerodigestive tract and was reported to be the cause of brain abscesses after esophageal dilatation or upper endoscopy. Case Presentation We report the case of a 53-year-old female who presented with hematemesis and melena followed by left-sided weakness. Initially, her hemiplegia was found to be secondary to a right thalamic brain abscess caused by S. intermedius. Investigations led to the diagnosis of a mid-esophageal squamous cell carcinoma. We hypothesize that the cause of the abscess with this bacterium that naturally resides in the digestive tract and oral cavity is secondary to hematogenous spread from breach in the mucosal integrity from ulceration due to the cancer. Conclusion To our knowledge, our case is the first in the literature to describe a brain abscess caused by S. intermedius in association with a previously undiagnosed esophageal squamous cell carcinoma without any prior esophageal intervention.

Microbial aetiology of brain abscess in a UK cohort: Prominent role of Streptococcus intermedius

“…The dominance of S. milleri species is consistent with other published UK epidemiological datasets on causative microbiology 7 , 14 , 29 and temporal trends in brain abscess epidemiology. 6 The dominant role of S. intermedius is also exemplified by case reports of brain abscesses [30][31][32][33][34] and noted to be a frequent species in the S. milleri group isolated from central nervous system specimens. 35 Another recent UK case series suggests the ' S. anginosus group' is predominant, but does not provide a breakdown of the S. milleri group by species.…”

Esophageal Perforation Presenting Initially as Multiple Brain Abscesses Secondary to Streptococcus intermedius

“…Bacterial migration from esophageal dilation and cancer has been reported as a cause of brain abscesses. 10 - 12 Hanna and Das 10 and Nayfe et al 11 reported 2 cases of brain abscesses caused by Streptococcus intermedius in association with esophageal adenocarcinoma and squamous cell carcinoma, respectively. To the best of our knowledge, our case is the first in the literature to describe brain abscesses caused by Streptococcus intermedius in association with esophageal perforation of unknown etiology.…”

“…Due to these different associations, the loss of esophageal mucosal integrity may be the main reason for brain abscess formation rather than the underlying disease. 11 The loss of mucosal integrity may have allowed gut flora to enter the bloodstream and cause bacterial spread to the brain. 11 …”

“… 11 The loss of mucosal integrity may have allowed gut flora to enter the bloodstream and cause bacterial spread to the brain. 11 …”

A Case of Streptococcus intermedius Abscess Within a Malignant Neck Mass and Review of the Literature

“…The remainder of the cases identified in our literature search were cancer patients who developed S. intermedius abscesses but who had not received radiation treatment. [8][9][10][11][12][13][14][15][16][17][18][19][20][21] One of these patients, like our patient, had tonsillar squamous cell carcinoma; however, this patient presented with a neck abscess before cancer diagnosis. 12…”