Title : Right thalamic abscess in a caucasian man with rheumatoid arthritis, an intriguing case report
Abstract:
Brain abscess is a localized collection of pus within the brain tissue. It is a rare condition and approximately 1500-2000 cases are presented annually in the United States. The patients with immunocompromised state have a higher incidence of acquiring brain abscess. The most frequent pathogens are streptococcus, staphylococcus, candida, cladophialophora. Most of the brain abscess are spread from contiguous sites, foreign bodies or surgical procedures. Common odontogenic sources include streptococcus, prevotella, haemophilus, fusobacterium. The most common presentation of brain abscess is headache, nuchal rigidity, seizures, cranial nerve deficits, altered mentation, fever, vomiting, and focal neurological deficit such as hemiparesis or aphasia.
Herein, we present the case of 57-year-old male patient with two-year history of rheumatoid arthritis since one and half year under treatment with methotrexate and etanercept, presented to our hospital with sudden onset headache, nausea, vomiting and fever for 5 days. Brain magnetic resonance imaging (MRI) illustrated right thalamic intracranial abscess. The right stereotactic brain biopsy was performed, and cultures were obtained which detected streptococcus intermedius.
He was treated successfully with ceftriaxone and metronidazole for the course of eight weeks with no neurological sequalae. To the best of our knowledge, thalamic intracranial abscess of dental origin in an immunocompromised patient is a rare presentation. A clinician should be aware of such patients and early recognition as well as early intervention are important to prevent long term sequalae.
