Case Report| Volume 20, ISSUE 11, P1625-1627, November 2013

Download started.


Intracerebral abscess with dissecting pneumocephalus caused by a gas-producing gram-positive rod following craniotomy for glioblastoma multiforme resection


      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.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Clinical Neuroscience
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Barazi S.A.
        • Gnanalingham K.K.
        • Chopra I.
        • et al.
        Delayed postoperative intracerebral abscess caused by Propionibacterium acnes: case report and review of the literature.
        Br J Neurosurg. 2003; 17: 336-339
        • Beeler B.A.
        • Crowder J.G.
        • Smith J.W.
        • et al.
        Proprionibacterium acnes: pathogen in central nervous system shunt infection. Report of three cases including immune complex glomerulonephritis.
        Am J Med. 1976; 61: 935-938
        • Blomstedt G.C.
        • Kyttä J.
        Results of a randomized trial of vancomycin prophylaxis in craniotomy.
        J Neurosurg. 1988; 69: 216-220
        • Bullock R.
        • van Dellen J.R.
        • Ketelbey W.
        • et al.
        A double blind placebo-controlled trial of perioperative prophylactic antibiotics for elective neurosurgery.
        J Neurosurg. 1988; 69: 687-691
        • Critchley G.
        • Strachan R.
        Postoperative subdural empyema caused by Propionibacterium acnes – a report of two cases.
        Br J Neurosurg. 1996; 10: 321-323
        • Cohen J.E.
        • Mierez R.
        • Tsai E.C.
        Postcraniotomy gas-containing brain abscess: a neurosurgical emergency. Case report.
        Surg Neurol. 1999; 51: 568-570
        • Cho K.T.
        • Park B.J.
        Gas-forming brain abscess caused by Klebsiella pneumoniae.
        J Korean Neurosurg Soc. 2008; 44: 382-384
        • Chu R.M.
        • Tummala R.P.
        • Hall W.A.
        Focal intracranial infections due to Propionibacterium acnes: report of three cases.
        Neurosurgery. 2001; 49: 717-720
        • Dashti S.R.
        • Baharvahdat H.
        • Spetzler R.F.
        • et al.
        Operative intracranial infection following craniotomy.
        Neurosurg Focus. 2008; 24: E10
        • Garfield J.
        Management of supratentorial intracranial abscess: review of 200 cases.
        Br Med J. 1969; 2: 7-11
        • Ghalayini S.R.
        • Likhith A.M.
        • Golash A.
        Propionibacterium acnes causing delayed subdural empyema – a case report and review of literature.
        J Clin Neurosci. 2004; 11: 677-679
        • Korinek A.M.
        Risk factors for neurosurgical site infections after craniotomy: a prospective multicenter study of 2944 patients. The French Study Group of Neurosurgical Infections, the SEHP, and the C-CLIN Paris-Nord. Service Epidémiologie Hygiène et Prévention.
        Neurosurgery. 1997; 41: 1073-1081
        • Kranick S.M.
        • Vinnard C.
        • Kolson D.L.
        Propionibacterium acnes brain abscess appearing 10 years after neurosurgery.
        Arch Neurol. 2009; 66: 793-795
        • Loeser Jr, E.
        • Scheimberg L.
        Brain abscesses: review of ninety-nine cases.
        Neurology. 1957; 7: 601-609
        • Lu C.H.
        • Chang W.N.
        • Lin Y.C.
        • et al.
        Bacterial brain abscess: microbiological features, epidemiological trends and therapeutic outcomes.
        QJM. 2002; 95: 501-509
        • McClelland 3rd, S.
        • Hall W.A.
        Postoperative central nervous system infection: incidence and associated factors in 2111 neurosurgical procedures.
        Clin Infect Dis. 2007; 45: 55-59
        • Nisbet M.
        • Briggs S.
        • Ellis-Pegler R.
        • et al.
        Propionibacterium acnes: an under-appreciated cause of post-neurosurgical infection.
        J Antimicrob Chemother. 2007; 60: 1097-1103
        • Norrell H.
        • Howieson J.
        Gas-containing brain abscess.
        AJR Am J Roentgenol. 1970; 109: 273-276
        • Ramos J.M.
        • Esteban J.
        • Soriano F.
        Isolation of Propionibacterium acnes from central nervous system infections.
        Anaerobe. 1995; 1: 17-20
        • Skinner P.R.
        • Taylor A.J.
        • Coakham H.
        Propionibacteria as a cause of shunt and postneurosurgical infections.
        J Clin Pathol. 1978; 31: 1085-1090
        • Tekkök I.H.
        • Higgins M.J.
        • Ventureyra E.C.G.
        Posttraumatic gas-containing brain abscess caused by Clostridium perfringens with unique simultaneous fungal suppuration by Myceliophthora thermophila: case report.
        Neurosurgery. 1996; 39: 1247-1251
        • Van Ek B.
        • Dijkmans B.A.
        • van Dulken H.
        • et al.
        Antibiotic prophylaxis in craniotomy: a prospective double blind placebo-controlled study.
        Scand J Infect Dis. 1988; 20: 633-639
        • Van Leer C.
        • Wensing A.M.
        • van Leeuwen J.P.
        • et al.
        Clostridium glycolicum isolated from a patient with otogenic brain abscesses.
        J Clin Microbiol. 2009; 47: 511-513
        • Vogelsang J.P.
        • Wehe A.
        • Markakis E.
        Postoperative intracranial abscess—clinical aspects in the differential diagnosis to early recurrence of malignant glioma.
        Clin Neurol Neurosurg. 1998; 100: 11-14