Somoza Andres V, Hanos Christina T, St Clair Jesse W, James Courtney L
Mayo Clinic Alix School of Medicine, Mayo Clinic College of Medicine and Science, Jacksonville, Florida.
Department of Family Medicine, Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Jacksonville, Florida.
Clin Pract Cases Emerg Med. 2025 May;9(2):149-153. doi: 10.5811/cpcem.33523.
A brain abscess is a localized collection of purulent infection within the brain parenchyma. It most often occurs due to contiguous spread from sinus, otogenic, and odontogenic infections; however, it can also develop from direct intracranial contact via trauma or surgery. Fusobacterium necrophorum, an obligate anaerobic, gram-negative bacillus, is part of the normal flora of the oral cavity. Given its inherent location, F necrophorum has been shown to contribute to complications stemming from infection of the tonsils, pharynx, and teeth. Invasive infections of F necrophorum are seldomly seen in immunocompetent patients.
We report a case of a previously healthy 20-year-old man who presented to our emergency department with headache, facial pain, and neck stiffness. He was ultimately found to have an F necrophorum intracranial abscess and underwent right frontal craniotomy with evacuation of epidural abscess and partial sinus obliteration. He was placed on broad-spectrum antibiotics, including vancomycin, cefepime, and metronidazole for six weeks. His treatment course was complicated by recurrence of intraparenchymal abscess requiring repeat craniotomy with abscess evacuation and advancement of antibiotic regimen to meropenem. To our knowledge, there are no reported cases in the literature of monomicrobial F necrophorum brain abscesses arising secondary to invasive sinusitis in immunocompetent adults.
This report highlights the clinical presentation, diagnostic strategies, management challenges, clinical outcomes, and complications of invasive sinusitis leading to brain abscess formation in an otherwise healthy adult male.
脑脓肿是脑实质内局限性化脓性感染灶。其最常因鼻窦、耳源性和牙源性感染的邻近扩散所致；然而，也可因创伤或手术导致的颅内直接接触而发生。坏死梭杆菌是一种专性厌氧的革兰氏阴性杆菌，是口腔正常菌群的一部分。鉴于其固有位置，坏死梭杆菌已被证明可导致扁桃体、咽部和牙齿感染引起的并发症。在免疫功能正常的患者中很少见到坏死梭杆菌的侵袭性感染。
我们报告一例病例，一名20岁既往健康男性因头痛、面部疼痛和颈部僵硬就诊于我院急诊科。最终发现他患有坏死梭杆菌颅内脓肿，并接受了右额开颅手术，清除硬膜外脓肿并部分闭塞鼻窦。他接受了为期六周的广谱抗生素治疗，包括万古霉素、头孢吡肟和甲硝唑。他的治疗过程因脑实质内脓肿复发而复杂化，需要再次开颅清除脓肿，并将抗生素方案升级为美罗培南。据我们所知，文献中尚无免疫功能正常的成年人因侵袭性鼻窦炎继发单一坏死梭杆菌脑脓肿的报道。
本报告强调了侵袭性鼻窦炎导致一名原本健康的成年男性发生脑脓肿的临床表现、诊断策略、管理挑战、临床结局及并发症。
