Brain abscess by Streptococcus anginosus because of chronic pansinusitis: a case report

Background: Streptococcus anginosus species is a commensal bacteria found in the oropharynx and nasopharynx, the gastrointestinal system, and the urogenital system. When pathogenic, they are often associated with the formation of abscesses wherever infection occurs. Predisposing factors for invasive infections include being immunocompromised, penetrating trauma, neurosurgical operation, bad oral/dental hygiene, and severe sinusitis. Case Description: We discuss a case of a 21-year-old male who suffered from an intraparenchymal brain abscess in the left frontal lobe, caused by a chronic pansinusitis. Cultures of the stereotactic drainage of the abscess showed Streptococcus anginosus species as causative pathogen. Intravenous antibiotics, ceftriaxone and metronidazole, were administered for 50 days. A total of three stereotactic drainages were necessary followed by surgical reconstruction of the frontal sinus cavities. Weekly controls with computed tomography (CT)-scans were taken during hospitalization. The patient was hospitalized for 7 weeks, of which 16 days at the intensive care department. After a rehabilitation process the patient had a full recovery. Conclusions: It is a rare infection in immunocompetent patients, but it is important to be vigilant for this disease presentation. It is important to perform the adequate imaging, adequate and long-lasting antibiotic treatment for at least 6 weeks, along with necessity of (sometimes multiple) surgical interventions.