Although brain abscess still continues to be a common condition, [1][2][3][4][5] it is rare in neonates. 6,7 Excluding patients with cranial or spinal dermal sinus, Staphylococcus brain abscess in infants is rare as well. We present an infant with staphylococcal brain abscess secondary to a neonatal breast abscess and highlight the unusual heretofore unreported presentation and possible complications.
Case ReportA 2-month-old male infant was transferred to us from a local hospital with a one-day history of fever, lethargy, altered level of consciousness, and generalized tonic clonic seizures. There was no history suggestive of cyanotic heart disease and pulmonary or cardiac infection. However, at the age of 3 weeks this infant had developed pyogenic mastitis, which soon developed into a breast abscess necessitating incision and drainage at a local hospital. The pus culture had grown Staphylococcus aureus sensitive to cloxacillin, which was given to the infant initially intravenously for 5 days and then orally for 10 days. Examination at the local hospital had revealed the patient to be febrile, lethargic and drowsy. Pupils were normal and there were no focal neurological deficits except for the neck stiffness. There was no evidence of dermal sinus anywhere in the body nor any portal of entry of infection. A diagnosis of meningitis was entertained and a lumbar puncture was carried out, which revealed frank pus. Pus smear showed gram-nositive cocci, which grew Staphylococcus aureus.Examination on admission to our hospital revealed high-grade pyrexia and tachypnea. There was no focal neurological deficit. Fundi revealed bilateral early papilledema and the anterior fontanelle was tense. Blood investigation showed 11.2 g% hemoglobin. Total leukocyte count was 18,400/dL, and the differential count revealed 88% neutrophils. The blood test for HIV was negative and the chest x-ray was normal. However, no blood cultures were done as the patient was only febrile for one day, and there was strong suggestion of meningitis. Plain and contrast-enhanced CT scan of the brain revealed left frontoparietal large brain abscess, with surrounding edema and midline shift ( Figures 1A and B). An emergency aspiration was undertaken, through a left frontal burr hole under general anesthesia and about 35 mL of thick yellow pus was evacuated. Pus smear showed gram-positive cocci and culture grew Staphylococcus aureus sensitive to a large number of antibiotics, including cloxacillin and cephalosporines. The patient received intravenous ceftriaxone and cloxacillin for 7 days. Subsequently, his temperature became normal and the level of consciousness improved. A repeat CT scan on the 7th postoperative day revealed residual left frontoparietal abscess (Figures 2A and B) with evidence of ventriculitis and mild ventricular dilatation. The CT scan also revealed multiple peripheral cerebellar infarcts (Figure 3) at this stage.