Complete resection of fungal brain abscess in a patient with chronic active Epstein-Barr virus infection using intraoperative MRI: A case report

• Chronic active Epstein-Barr virus (CAEBV) can cause life-threatening brain abscesses. • Craniotomy is better than aspiration for complete and rapid treatment of abscesses. • Intraoperative MRI is vital for accurate resection of CAEBV-caused brain abscesses. • Craniotomy is viable for treatment when complete removal is essential. Chronic active Epstein-Barr virus (CAEBV) infection is a rare, life-threatening disease for which the only curative treatment is allogeneic hematopoietic stem cell transplantation (HSCT). Here, we report a case of a brain abscess caused by a CAEBV infection. Brain abscesses can be surgically treated using craniotomy or aspiration. The advantage of craniotomy over aspiration is that it enables complete removal of the suppurative material and surrounding abscess sacs, allowing for more reliable and rapid treatment, potentially reducing the duration of antibiotic therapy and the need for additional treatment. Intraoperative magnetic resonance imaging (MRI), a powerful brain imaging tool, allows visualization of the resection of intraparenchymal lesions and should be used when more accurate removal is needed. Case Description: A 28-year-old man presented with a brain abscess caused by CAEBV. Before allogeneic HSCT was performed, total excision of the abscess was necessary to avoid aggravation of the infection. A craniotomy was performed using intraoperative MRI to achieve complete and reliable resection and confirm total resection of the abscess. No postoperative complications occurred, and postoperative MRI showed no recurrence of the abscess. Although the role of craniotomy is limited by advances in minimally invasive surgery, such as stereotactic aspiration, it should be considered to achieve total removal of an abscess. Intraoperative MRI is useful for confirming complete resection of the abscess in a specific case.