An Official publication of The Asian Congress of Neurological Surgeons (AsianCNS)

Search Article
Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Advertise Subscribe Contacts Login  Facebook Tweeter
  Users Online: 1098 Home Print this page Email this page Small font sizeDefault font sizeIncrease font size  

   Table of Contents      
LETTER TO EDITOR
Year : 2020  |  Volume : 15  |  Issue : 1  |  Page : 245-246

A rare case of Achromobacter species subdural empyema and brain abscess in an adult patient with hematologic malignancy


Department of Neurosurgery, Asclepeion General Hospital of Athens, Voula, Athens, Greece

Date of Submission29-Dec-2019
Date of Acceptance24-Jan-2020
Date of Web Publication25-Feb-2020

Correspondence Address:
Dr. Aristedis Rovlias
Department of Neurosurgery, Asclepeion General Hospital of Athens, 1 Vasileos Pavlou Street, 16 673, Voula, Athens
Greece
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ajns.AJNS_373_19

Rights and Permissions

How to cite this article:
Rovlias A. A rare case of Achromobacter species subdural empyema and brain abscess in an adult patient with hematologic malignancy. Asian J Neurosurg 2020;15:245-6

How to cite this URL:
Rovlias A. A rare case of Achromobacter species subdural empyema and brain abscess in an adult patient with hematologic malignancy. Asian J Neurosurg [serial online] 2020 [cited 2020 Jul 13];15:245-6. Available from: http://www.asianjns.org/text.asp?2020/15/1/245/279049



Sir,

Focal intracranial infections remain a major source of morbidity and are often life-threatening conditions. Rapid recognition and early neurosurgical intervention combined with appropriate antimicrobial treatment give the best chances of a favorable prognosis.[1] We describe a rare case of a subdural empyema (SDE) and adjacent cerebral abscess from Achromobacter species in a young patient with hematologic malignancy.

A 39-year-old Caucasian female with multiple myeloma, was admitted in the emergencies with fever, headache, vomiting, gait disturbance, and seizures for 4 days. Neurological examination revealed a left hemiparesis, nuchal rigidity, and positive Babinski sign. Pre- and post-contrast computed tomography and magnetic resonance imaging brain scans were suggestive of right frontal SDE and adjacent early capsule formation brain abscess with perifocal edema [Figure 1]a, [Figure 1]b, [Figure 1]c, [Figure 1]d.
Figure 1:(a) Brain computed tomography scan without contrast, and (b) T1 – weighted postcontrast image reveals a hyperdense to cerebrospinal fluid right frontal subdural collection with clear capsule formation, and an adjacent intraparenchymal lesion of low signal with considerable edema. (c) Fluid-attenuated inversion recovery postcontrast sequence demonstrates a densely enhancing extraaxial lesion and a well-defined ring enhancing brain lesion. (d) On diffusion-weighted image, the core of the subdural and brain lesion has typically markedly hyperintense signal (restricted diffusion)

Click here to view


The patient underwent right frontal craniectomy and complete removal of SDE and cerebral abscess [Figure 2]. Achromobacter xylosoxidans colonies were identified from blood samples and intracranial pus cultured on MacConkey agar. The patient received a combination of Piperacillin– Tazobactam and trimethoprim/sulfamethoxazole (TMP/SMX) intravenously for 6 weeks and she gradually recovered. She was also given oral TMP/SMX for a further 2 months, and at the time of writing this study, she is still well 1½ years after completion of therapy [Figure 3].
Figure 2: Purulent material into the subdural space after opening of the dura mater and the subdural empyema capsule

Click here to view
Figure 3: Postcontrast computed tomography scan 3 weeks after surgical procedure reveals the intracranial infections decreased

Click here to view


Achromobacter species is often isolated from aqueous environments but is rarely recognized as a human pathogen. However, it can cause serious infections in immunosuppressed patients. Achromobacter infections in patients with cancer, and especially in those who have underlying hematologic malignancies, usually are seen as uncomplicated hematogenous infections and are seldom accompanied by a secondary suppurative focus of infection.[2],[3] Isolation of Achromobacter xylosoxidans from intracranial space was an unusual finding and to the best of our knowledge is the first case that Achromobacter xylosoxidans implicated for an intracranial abscess formation in an adult patient who had not undergone any prior neurosurgical procedure.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Kastrup O, Wanke I, Maschke M. Neuroimaging of infections. NeuroRx 2005;2:324-32.  Back to cited text no. 1
    
2.
Shie SS, Huang CT, Leu HS. Characteristics of Achromobacter xylosoxidans bacteremia in Northern Taiwan. J Microbiol Immunol Infect 2005;38:277-82.  Back to cited text no. 2
    
3.
Aisenberg G, Rolston KV, Safdar A. Bacteremia caused by Achromobacter and Alcaligenes species in 46 patients with cancer (1989-2003). Cancer 2004;101:2134-40.  Back to cited text no. 3
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

Top
 
 
  Search
 
<
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)  

 
  In this article
   References
   Article Figures

 Article Access Statistics
    Viewed203    
    Printed3    
    Emailed0    
    PDF Downloaded32    
    Comments [Add]    

Recommend this journal