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A rare case of brain abscess caused by Actinomyces meyeri

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 cause...

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Autores principales: Sah, Ranjit, Nepal, Gaurav, Sah, Sanjit, Singla, Sonam, Upadhyay, Priti, Rabaan, Ali A., Dhama, Kuldeep, Rodriguez-Morales, Alfonso J., Ghimire, Rabindra
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7251899/
https://www.ncbi.nlm.nih.gov/pubmed/32460724
http://dx.doi.org/10.1186/s12879-020-05100-9
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author Sah, Ranjit
Nepal, Gaurav
Sah, Sanjit
Singla, Sonam
Upadhyay, Priti
Rabaan, Ali A.
Dhama, Kuldeep
Rodriguez-Morales, Alfonso J.
Ghimire, Rabindra
author_facet Sah, Ranjit
Nepal, Gaurav
Sah, Sanjit
Singla, Sonam
Upadhyay, Priti
Rabaan, Ali A.
Dhama, Kuldeep
Rodriguez-Morales, Alfonso J.
Ghimire, Rabindra
author_sort Sah, Ranjit
collection PubMed
description 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.
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spelling pubmed-72518992020-06-07 A rare case of brain abscess caused by Actinomyces meyeri Sah, Ranjit Nepal, Gaurav Sah, Sanjit Singla, Sonam Upadhyay, Priti Rabaan, Ali A. Dhama, Kuldeep Rodriguez-Morales, Alfonso J. Ghimire, Rabindra BMC Infect Dis Case Report 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. BioMed Central 2020-05-27 /pmc/articles/PMC7251899/ /pubmed/32460724 http://dx.doi.org/10.1186/s12879-020-05100-9 Text en © The Author(s) 2020 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Case Report
Sah, Ranjit
Nepal, Gaurav
Sah, Sanjit
Singla, Sonam
Upadhyay, Priti
Rabaan, Ali A.
Dhama, Kuldeep
Rodriguez-Morales, Alfonso J.
Ghimire, Rabindra
A rare case of brain abscess caused by Actinomyces meyeri
title A rare case of brain abscess caused by Actinomyces meyeri
title_full A rare case of brain abscess caused by Actinomyces meyeri
title_fullStr A rare case of brain abscess caused by Actinomyces meyeri
title_full_unstemmed A rare case of brain abscess caused by Actinomyces meyeri
title_short A rare case of brain abscess caused by Actinomyces meyeri
title_sort rare case of brain abscess caused by actinomyces meyeri
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7251899/
https://www.ncbi.nlm.nih.gov/pubmed/32460724
http://dx.doi.org/10.1186/s12879-020-05100-9
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