Abstract
Propionibacterium acnes (P. acnes), an indolent and slow-growing anaerobic gram-positive bacterium, has largely been
known as a commensal organism of the normal skin flora. However, P. acnes is increasingly being recognized as the causative infectious organism complicating
craniotomies and shunt insertions. To our knowledge, we present the first reported
patient with an intracerebral abscess with dissecting pneumocephalus caused by P. acnes. A 58-year-old woman who was immunocompetent presented 3 weeks after a craniotomy for resection of a glioblastoma multiforme with worsening
mental status, lethargy and left hemiparesis. Head CT scans and MRI demonstrated significant
vasogenic edema and dissecting pneumocephalus in the resection cavity. A craniotomy
was performed and purulent material was found in the subdural space and resection
cavity. Cultures were positive for P. acnes. She completed a full course of intravenous antibiotics appropriate for the organism.
The infection was eradicated and the patient survived albeit with persistent deficits.
This case illustrates the importance of considering an underlying intracerebral abscess
in patients with worsening neurological function and pneumocephalus on imaging several
weeks after surgery. Our review of the literature underscores the great importance
in early recognition and treatment with both surgical debridement and antibiotic therapy
in achieving optimal patient recovery.
Keywords
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Article info
Publication history
Accepted:
September 14,
2012
Received:
August 28,
2012
Identification
Copyright
© 2013 Elsevier Ltd. Published by Elsevier Inc. All rights reserved.
