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Photo Quiz (For answer and discussion, see page 2407 in this issue [doi:10.1128/JCM.01751-14].)
Frontal Brain Abscesses in an Immunocompetent Patient James Walter Snyder, Bradley Gibson Department of Pathology and Laboratory Medicine, University of Louisville, Louisville, Kentucky, USA
FIG 1 (Left) Resected cyst wall (hematoxylin and eosin; magnification, ⫻400). (Top right) Positive culture on potato flake agar (lactophenol cotton blue preparation; magnification, ⫻100). (Bottom right) Lactophenol cotton blue preparation; magnification, ⫻400.
A
59-year-old male with a past medical history of chronic obstructive pulmonary disease, hyperlipidemia, and gastroesophageal reflux disease and a recent history of upper left molar pain and rightsided body numbness was found by his wife to be having seizure activity while asleep. Upon arrival to the emergency department, he had no recollection of the event but was otherwise alert and oriented. He had several beats of clonus on the right foot. Magnetic resonance imaging demonstrated rim-enhancing cystic lesions measuring up to 2.1 cm in the bilateral frontal lobes with associated vasogenic edema. A positive blood culture was reported as “Gram-positive rods morphologically suggestive of Bacillus/Clostridium species.” The patient was placed on levetiracetam and intravenous ceftriaxone and metronidazole and discharged. Follow-up with dentistry was planned to evaluate for dental pathology as a source of bacteremia. Within 2 weeks, there was an interval increase in lesion size on
September 2016 Volume 54 Number 9
imaging. The patient was readmitted to the hospital, with subsequent biopsy, culture, and resection of the cystic lesions and placement of an Omaya reservoir. Gram stain of brain aspirate revealed fungal elements consisting of septated hyphae. Within 6 days of incubation, fungal cultures on potato flake agar grew a black-togray, velvety mold. The tissue pathology and lactophenol cotton blue preparation of the fungal cultures are shown in Fig. 1.
Citation Snyder JW, Gibson B. 2016. Frontal brain abscesses in an immunocompetent patient. J Clin Microbiol 54:2215. doi:10.1128/JCM.01750-14. Editor: P. Bourbeau Address correspondence to James Walter Snyder, [email protected]. Copyright © 2016, American Society for Microbiology. All Rights Reserved.
Journal of Clinical Microbiology
jcm.asm.org
2215
Photo Quiz (For answer and discussion, see page 2407 in this issue [doi:10.1128/JCM.01751-14].)
Frontal Brain Abscesses in an Immunocompetent Patient James Walter Snyder, Bradley Gibson Department of Pathology and Laboratory Medicine, University of Louisville, Louisville, Kentucky, USA
FIG 1 (Left) Resected cyst wall (hematoxylin and eosin; magnification, ⫻400). (Top right) Positive culture on potato flake agar (lactophenol cotton blue preparation; magnification, ⫻100). (Bottom right) Lactophenol cotton blue preparation; magnification, ⫻400.
A
59-year-old male with a past medical history of chronic obstructive pulmonary disease, hyperlipidemia, and gastroesophageal reflux disease and a recent history of upper left molar pain and rightsided body numbness was found by his wife to be having seizure activity while asleep. Upon arrival to the emergency department, he had no recollection of the event but was otherwise alert and oriented. He had several beats of clonus on the right foot. Magnetic resonance imaging demonstrated rim-enhancing cystic lesions measuring up to 2.1 cm in the bilateral frontal lobes with associated vasogenic edema. A positive blood culture was reported as “Gram-positive rods morphologically suggestive of Bacillus/Clostridium species.” The patient was placed on levetiracetam and intravenous ceftriaxone and metronidazole and discharged. Follow-up with dentistry was planned to evaluate for dental pathology as a source of bacteremia. Within 2 weeks, there was an interval increase in lesion size on
September 2016 Volume 54 Number 9
imaging. The patient was readmitted to the hospital, with subsequent biopsy, culture, and resection of the cystic lesions and placement of an Omaya reservoir. Gram stain of brain aspirate revealed fungal elements consisting of septated hyphae. Within 6 days of incubation, fungal cultures on potato flake agar grew a black-togray, velvety mold. The tissue pathology and lactophenol cotton blue preparation of the fungal cultures are shown in Fig. 1.
Citation Snyder JW, Gibson B. 2016. Frontal brain abscesses in an immunocompetent patient. J Clin Microbiol 54:2215. doi:10.1128/JCM.01750-14. Editor: P. Bourbeau Address correspondence to James Walter Snyder, [email protected]. Copyright © 2016, American Society for Microbiology. All Rights Reserved.
Journal of Clinical Microbiology
jcm.asm.org
2215
