Rare case of intracranial Salmonella enteritidis abscess following glioblastoma resection: Case report and review of the literature

BACKGROUND: Worldwide, Salmonella enteritidis (SE) is becoming a common cause of gastrointestinal infections by contaminated food products, mainly eggs. Extra-intestinal manifestations such as brain abscess are more commonly associated with Salmonella typhimurium and are rare in adults. We report the clinical features, treatment outcomes and risk factors predisposing our patient to Salmonella enteritidis brain abscess and discuss relevant literature. CASE DESCRIPTION: A 57-year-old-man developed SE subdural empyema, abscess and possible ventriculitis following reoperation for progression of a right temporal glioblastoma. He initially presented with rapidly worsening headaches over a few days, with a wound discharge and associated meningeal signs. An emergent wound washout revealed pus in the epidural, subdural space and resection cavity. An external ventricular drain (EVD) was placed and cultures revealed gram negative rods. Timely intervention, EVD, and antibiotics resulted in complete resolution. Nine cases of Salmonella abscess associated with primary brain tumor have been reported in literature, most frequently caused by SE in association with glioblastoma multiforme (GBM). We describe our management and outcome in addition to discussing neurosurgical literature on the reported cases. CONCLUSIONS: Re-operative tumor surgery has a higher incidence of post-operative infections, with Gram positive cocci being the most common pathogens. Predisposing factors reported for intracranial salmonellosis include compromised immunity, diabetes, HIV, and recent travel. Chronic corticosteroid use, multiple regimens of chemotherapy, and regions of tumor necrosis likely potentiate this rare infection in GBM patients.