Actinomyces israelii Brain Abscess With Advanced HIV Disease

TL;DR

A three-year-old girl with advanced HIV developed a rare brain abscess caused by Actinomyces israelii, successfully treated with surgery and long-term antibiotics.

Contribution

First reported case of Actinomyces israelii CNS abscess in a pediatric patient with advanced HIV.

Findings

Actinomyces israelii was identified as the causative agent via PCR in a pediatric CNS abscess.

Multidisciplinary treatment including neurosurgery and antiretroviral therapy led to significant recovery.

The case highlights the importance of considering A. israelii in immunocompromised pediatric patients with CNS lesions.

Abstract

We present the first reported case of a pediatric central nervous system (CNS) abscess caused by Actinomyces israelii in the context of advanced HIV disease. A three-year-old girl from São Tomé and Príncipe presented with progressive neurological deficits, including gait instability and language delay. Brain MRI revealed a right temporal lobulated lesion with surrounding edema and mass effect. Chronic superior sagittal sinus thrombosis and hydrocephalus were also identified. Neurosurgical intervention included ventriculocisternostomy and microsurgical resection of the lesion, which revealed a multiloculated abscess. Histology confirmed granuloma formation, and polymerase chain reaction (PCR) identified A. israelii. HIV serology was positive, with a CD4 count of 664 cells/μL and a viral load of 1,340,000 copies/mL. The patient received a year-long antibiotic regimen, starting with intravenous penicillin G followed by oral amoxicillin, and antiretroviral therapy was initiated. She showed marked improvement in neurological function and no signs of relapse after one year. This case underscores the importance of considering A. israelii in the differential diagnosis of CNS lesions in immunocompromised pediatric patients. It also highlights the critical role of neurosurgery, molecular diagnostics, and multidisciplinary management in ensuring favorable outcomes.

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