A case report of brain abscess caused by Streptococcus intermedius secondary to sinusitis in 16-year-old adolescents

Abstract

Background: A brain abscess is a rare but serious complication of sinusitis. It mostly involves adolescents and more specifically those of the male sex. A cerebral abscess is characterized by a heterogeneous clinical picture. The pathogenic organism mostly involved belongs to the Streptococcus milleri group. The diagnosis process is based on imaging. Treatment is based on an antibiotic therapy for 4-8 weeks which can be followed by surgery. Long-term sequelae occur in 40% of the cases, and mortality is about 10%. Case Presentation: This paper reports the clinical case of a 16-year-old boy affected by a sinusitis-induced brain abscess. The worsening of the clinical picture and of the neuroimaging, despite antibiotic therapy, made a surgical intervention necessary. An intravenous antibiotic therapy was administered for 2 weeks followed by oral antibiotics. Despite this, the condition of the patient was worsening, and he had to be treated again with intravenous antibiotic therapy for 4 weeks. This therapeutic choice had a positive outcome and the boy was declared healed. Conclusion: Sinusitis is an infection that can be complicated by brain abscess in 6%-8% of cases. Large-sized cerebral abscesses accompanied by neurological symptoms require prompt surgical treatment and a targeted antimicrobial therapy to reduce hospitalization and to speed up the healing process.