Odontogenic (hematogenic) or sinusopathy (contiguous) brain abscess: Case report

TL;DR

A 22-year-old woman developed a brain abscess possibly linked to a dental infection, highlighting the challenges in diagnosing and treating such rare conditions.

Contribution

This case report highlights an unusual brain abscess potentially linked to sinusitis or a dental infection in an immunocompetent young woman.

Findings

A brain abscess caused by multidrug-resistant Streptococcus sanguis was identified in a 22-year-old patient.

Gemella morbillorum was found in maxillary sinusitis, suggesting a possible dental origin of the infection.

Treatment required multiple interventions, including drainage, surgery, and prolonged antibiotics, with recurrence observed.

Abstract

Brain abscess is a rare infectious condition, affecting 0.4 to 0.9 per 100,000 individuals annually, with classic symptoms of fever, headache, and neurological deficits. The origin can be contiguous, hematogenous, due to ruptures of brain barriers, or cryptogenic. Dental infections, such as those related to Gemella morbillorum, are atypical, and when related to odontogenic sinusitis, it is normally unilateral. This report describes a case of peculiar brain abscess, of unconfirmed source, possibly involving sinusitis or periapical odontogenic lesion in an immunocompetent young woman. A 22-year-old patient presented with sinusitis showed by computed tomography, progressing to a brain abscess caused by multidrug-resistant Streptococcus sanguis. Additional cultures revealed Gemella morbillorum in maxillary sinusitis. Treatment involved stereotactic drainage, sinusotomy, and prolonged antibiotic therapy, with recurrence and surgical reintervention, in addition to prophylactic dental extraction and exerese of the brain cyst capsule. Brain abscess represents a significant medical challenge, often posing difficulties in pinpointing its primary infectious source despite the aid of comprehensive laboratory and imaging diagnostics, as evidenced in this case. Timely and targeted intervention in preceding infections assumes paramount importance for effective management, underscoring the indispensable role of a multidisciplinary healthcare team. Active patient engagement and adherence to treatment protocols are imperative to mitigate complications and foster favorable disease progression.

Key words:Brain Abscess, Dental Focal Infection, Gemella, Sinusitis, Streptococcus sanguis.

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