From Seizure to Cerebral Actinomycosis: A Deceptive Case and an Unexpected Diagnosis Behind a Pseudotumoral Lesion

Cerebral actinomycosis is a rare bacterial infection of the central nervous system, often under-recognized due to its non-specific clinical and radiological presentation, which can mimic a tumor or other infectious process. We report the case of a 53-year-old man with no significant medical history who was admitted for status epilepticus preceded by headaches. Brain imaging (CT and MRI) revealed multiple loculated frontal lesions with surrounding edema and mass effect, suggestive of a pseudotumoral or aggressive infectious process. Despite investigations and empirical antibiotic therapy, the lack of improvement led to a craniotomy with abscess drainage. Histopathological analysis confirmed the diagnosis of cerebral actinomycosis. The patient showed a favorable outcome under third-generation cephalosporin therapy. This case highlights the importance of including cerebral actinomycosis in the differential diagnosis of brain abscesses and pseudotumoral lesions, even in patients without obvious risk factors. Diagnosis relies on histopathological examination, and management requires a combination of surgical intervention and prolonged antibiotic therapy. Clinical vigilance is crucial for early diagnosis and treatment, thereby improving prognosis.