A brain abscess caused by Encephalitozoon cuniculi genotype I together with Streptococcus intermedius occurred in a patient without major immunocompromise and with diabetes. The distinguishing clinical signs were hemiparesis and epilepsy. The microsporidium was observed in the abscess aspirate, and its specific DNA was also detected in stool and urine. The patient was successfully treated with albendazole and mebendazole.
CASE REPORTA 56-year-old male patient with a history of myocardial infarction years ago, recently diagnosed with type II diabetes mellitus treated with metformin and hypertension treated with antihypertensives, was transferred from a county referral hospital with a 5-day history of illness that after two episodes of loss of conscience with generalized seizures left him with residual hemiparesis on the left side and severe cognitive impairment, along with a temperature of 39.5°C. By occupation, he is a groundskeeper in city parks. Prior to admission he spent most of his work time mowing lawns.The initial cranial CT scan did not detect any pathology except for some fluid in his paranasal sinuses-right-sided frontal, ethmoid, and maxillary sinusitis. Lumbar puncture revealed a mild elevation in protein (99 mg/dl) and leukocytes (14 cells/l, 63% segmented neutrophils and 37% lymphocytes) (corresponding to the initial stage of aseptic meningitis). General markers of systemic inflammation (leukocytes, C-reactive protein [CRP], and procalcitonin in serum) did not suggest bacterial infection. The preliminary diagnosis was viral encephalitis, most likely tick-borne, complicated by sinusitis.The initial therapy included diazepam, phenytoin, omeprazole, dexamethasone, mannitol, tiapride, and empirical amoxicillin clavulanate due to the fluid present in the sinuses. Due to the progression of left-sided regional seizures to generalized seizures and to status epilepticus, he was intubated 5 days after admission and mechanically ventilated for 3 days. After extubation, his state of conscience improved to Glasgow coma scale 15, with no subsequent seizures, and the patient manifested only residual weakness of his left hand. His temperature normalized and antibiotics were discontinued after 10 days. CRP and procalcitonin never exceeded 35 mg/liter and 0.2 ng/ml, respectively.