Cerebellar abscess originating from an unexpected source: Case illustration

Background: Cerebellar abscesses are uncommon and most frequently occur in the setting of immunosuppression, systemic infection, or contiguous spread from otomastoiditis or otitis media. Subcutaneous abscesses have not previously been described as a source of intracranial abscess formation. Case Description: We present an unusual case of a 32-year-old previously healthy female with progressive headache, vomiting, and neurological deterioration. Computed tomography and magnetic resonance imaging demonstrated a right cerebellar hemisphere mass with significant surrounding edema and mass effect. Initial differential diagnosis included high-grade glioma and metastatic disease. Surgical exploration confirmed a cerebellar abscess. Extensive workup failed to identify conventional etiologies; however, the patient had recently undergone drainage and antibiotic treatment for a subcutaneous abscess. Microbiological analysis identified the same microorganism in both the subcutaneous and cerebellar abscesses, suggesting hematogenous dissemination from the initial soft-tissue infection. These findings strongly suggest that the initial infection led to the cerebellar abscess. Conclusion: This case study highlights a rare and previously undescribed source of cerebellar abscess formation in an immunocompetent patient. Clinicians should consider subcutaneous abscesses as a potential etiology of intracranial abscess when the most common causes of infectious sources are not identified.