J Clin Neurol.  2014 Oct;10(4):358-362. 10.3988/jcn.2014.10.4.358.

Drastic Therapy for Listerial Brain Abscess Involving Combined Hyperbaric Oxygen Therapy and Antimicrobial Agents

• Nakahara K
• Yamashita
• Ideo K
• Shindo S
• Suga T
• Ueda A
• Honda S
• Hirahara T
• Watanabe M
• Yamashita
• Maeda Y
• Yonemochi
• Takita T
• Ando Y

• KMID: 2287517
• DOI: http://doi.org/10.3988/jcn.2014.10.4.358

Abstract

BACKGROUND
Listeria monocytogenes (L. monocytogenes) is a rare causative pathogen of brain abscess that is often found in immunocompromised patients. Although patients with supratentorial listerial abscesses showed a longer survival with surgical drainage, the standard therapy for patients with subtentorial lesions has not been established.
CASE REPORT
We report herein a patient with supra- and subtentorial brain abscesses caused by L. monocytogenes infection. These abscesses did not respond to antibiotics, and his symptoms gradually worsened. Drainage was not indicated for subtentorial lesions, and the patient was additionally treated with hyperbaric oxygen therapy, which dramatically reduced the volume of abscesses and improved the symptoms.
CONCLUSIONS
This is the first report of drastic therapy for a patient with listerial brain abscesses involving combined antibiotics and hyperbaric oxygen therapy. The findings suggest that hyperbaric oxygen therapy is a good option for treating patients with deep-seated listerial abscesses and for who surgical drainage is not indicated.

Keyword

brain abscess; Listeria monocytogenes; subtentorial lesions; surgical drainage; hyperbaric oxygen therapy; antimicrobial agents

MeSH Terms

Abscess
Anti-Bacterial Agents
Anti-Infective Agents*
Brain Abscess*
Drainage
Humans
Hyperbaric Oxygenation*
Immunocompromised Host
Listeria monocytogenes
Anti-Bacterial Agents
Anti-Infective Agents

Figure

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  Fig. 1 Brain magnetic resonance imaging on admission. A: Fluid-attenuated inversion-recovery images disclosed iso- to hypointensity lesions in the midbrain and left cerebral hemisphere with surrounding edema. B: T1-weighted images with gadolinium enhancement showed ring enhancement in these lesions. C: High-intensity signals were present inside in the lesions in diffusion-weighted imaging. D: Susceptibility-weighted imaging revealed a dual rim sign: defined as two concentric rims at the lesion margins, with the outer rim being hypointense and the inner rim hyperintense relative to the cavity contents.

• 

  Fig. 2 Clinical course of the patient. Hyperbaric oxygen therapy (HBO; 100% O2 at 196.1 kPa abs at 1 h/day for 25 days) was performed between August 17 and September 20. After the treatment, the patient's consciousness status, right hemiparesis, and pleocytosis gradually improved. The diameter of the brain abscesses was dramatically reduced. ABPC: ampicillin.

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