Multiple brain abscesses in a neonate: a rare case report along with review of literature

Abstract

Introduction and importance: Brain abscess (BA) is a pyogenic infection of the brain parenchyma caused by various organisms. Multiple BAs are uncommon in neonates, and Candida albicans as a causative agent is very rare. If left untreated, BAs are invariably fatal. Early diagnosis, prompt surgical intervention, simultaneous eradication of the primary source, and high-dose intravenous antibiotics decrease the incidence of morbidity and mortality.

Case presentation: A 20-day-old newborn, delivered normally at term with a full APGAR score, presented with a 5-day history of fever, decreased activity, jaundice, and seizures. Imaging identified multiple cerebral cysts, diagnosed as multiple cerebral abscesses. Treatment involved intraoperative USG-guided burr-hole drainage, followed by a 6-week antifungal therapy course. C. albicans was found to be the causative organism following microscopic examination and culture of the pus.

Clinical discussion: This literature highlights the rarity of fungal involvement in multiple cerebral abscesses in neonates. Managing such cases is very challenging, as the presentation may mimic bacterial infections. The importance of considering fungi as a causative agent in treatment decisions is crucial.

Conclusion: Multiple BAs of fungal origin are extremely rare. Early detection and management of cases can reduce mortality among neonates.

Keywords: brain abscesses; candida abscesses; candida brain abscess; multiple cerebral abscess; neonates.

Figure 1

Noncontrast axial T1 MRI (A) and post-gadolinium Axial (B) and sagittal (C) MRI showing multiple rims enhancing lesions in the bilateral cerebral hemispheres in b frontal, parietal, temporal and occipital lobes. The largest lesion on the right side (arrow) measured ~1.5 cm×1.3 cm.

Figure 2

Contrast-enhanced computed tomography scan in 6 weeks after surgery revealing near complete resolution of the abscesses. CECT head done after 6 weeks of management showing near complete resolution of abscess which was present earlier in frontal temporal and occipital lobe reinforcing our management for brain abscess.

Figure 3

Photomicrograph showing Gram-positive budding yeast cells (A) and formation of germ tube by Candida albicans (B).