Brain Tumor Res Treat.  2018 Oct;6(2):92-96. 10.14791/btrt.2018.6.e16.

Brain Abscess Showing a Lack of Restricted Diffusion and Successfully Treated with Linezolid

Affiliations
  • 1Department of Neurosurgery, Eulji University, Nowon Eulji Medical Center, Seoul, Korea. drkdr@hanmail.net

Abstract

A 59-year-old patient with a history of hepatocellular carcinoma presented with decreased consciousness and left hemiparesis. A rim-enhanced mass lesion without diffusion restriction was observed in contrast-enhanced MRI including diffusion-weighted imaging. Based on these findings, metastatic brain tumor was suspected. However, brain abscess (BA) was diagnosed after multiple bacterial colonies were observed in aspiration biopsy. Initial conventional antibiotic treatment including vancomycin had failed, so linezolid was used as second-line therapy. As a result, infection signs and clinical symptoms were resolved. We report a case with atypical imaging features and antibiotic susceptibility of a BA in an immunocompromised patient undergoing chemotherapy.

Keyword

Brain abscess; Diffusion Magnetic Resonance Imaging; Linezolid

MeSH Terms

Biopsy, Needle
Brain Abscess*
Brain Neoplasms
Brain*
Carcinoma, Hepatocellular
Consciousness
Diffusion Magnetic Resonance Imaging
Diffusion*
Drug Therapy
Humans
Immunocompromised Host
Linezolid*
Magnetic Resonance Imaging
Middle Aged
Paresis
Vancomycin
Linezolid
Vancomycin

Figure

  • Fig. 1 Preoperative MRI images. A: T2-weighted fluid attenuated inversion recovery axial magnetic resonance (MR) image shows a multilobulated cystic mass lesion in the right parieto-occipital lobe with hemorrhagic and necrotic change. B: Rim enhancement mass-like lesions on post-contrast T1-weighted axial MR image. C: Diffusion-weighted MR image shows hypointensity in the cavity. D: Corresponding hypointensity on the apparent diffusion coefficient map.

  • Fig. 2 Axial contrast-enhanced CT images showing multiple cystic lesions with rim enhancement in temporal and occipital lobe. A and B: About 3 weeks after the initial antibiotic treatment including vancomycin. C and D: After secondary abscess aspiration and a change in antibiotics as linezolid 4 weeks later.


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