Propionibacterium acnes‐associated neurosarcoidosis: A case report with review of the literature

Abstract

A 56-year-old woman with a 3-year history of hydrocephalus and ventriculo-peritoneal shunt placement, presented with worsening altered level of consciousness for 2 days. Imaging studies showed severe ventriculomegaly involving the lateral and third ventricles with multiple septated cysts noted in the lateral ventricles predominantly near the frontal horns. Histopathologic examination of the excised brain lesion revealed choroid plexus tissue and adjacent cerebral parenchyma with several non-caseating granulomas. Granulomatous inflammation was also identified in mediastinal lymph nodes. By using specific monoclonal antibodies, Propionibacterium acnes (P. acnes) were detected in non-caseating granulomas of both the brain and mediastinal lymph nodes. No acid-fast bacilli or fungal elements were present. To the best of our knowledge, this is the first demonstration of P. acnes in sarcoid granulomas of cerebral tissue, and it reinforces the possible link between P. acnes and sarcoidosis.

Propionibacterium acnes-associated chronic hypertrophic pachymeningitis followed by refractory otitis media: a case report

“…Yang et al reported a case of P. acnes-associated neurosarcoidosis identified by immunohistochemical analysis of the brain tissue using PAB antibody [25]. Contrarily, our case differs from sarcoidosis because pathological analyses did not reveal the presence of noncaseating granulomas.…”

Propionibacterium acnes-associated chronic hypertrophic pachymeningitis followed by refractory otitis media: A Case Report

“…Yang et al reported a case of P. acnes-associated neurosarcoidosis identified by immunohistochemical analysis of the brain tissue using PAB antibody [25]. Contrarily, our case differs from sarcoidosis because pathological analyses did not reveal the presence of non-caseating granulomas.…”

Moving target: shifting the focus to pulmonary sarcoidosis as an autoimmune spectrum disorder

“…Broad-spectrum anti-mycobacterial therapy has demonstrated positive effects on lung function in chronic sarcoidosis patients [46], although this was primarily attributed to anti-inflammatory effects rather than specific pathogen eradication [47]. In addition, P. acnes has been associated particularly with certain manifestations of sarcoidosis such as ocular, cardiac and neurological involvement [48][49][50][51], and more recent studies show alterations in the pulmonary microbiome in sarcoid compared to healthy lungs [52]. However, as presence of bacterial DNA [53] and protein [5] have been reported in ∼50% of investigated sarcoidosis patients, and as live mycobacteria have never been identified in or cultured from sarcoid lungs, these findings cannot account for all patients.…”