Abstract
We describe the first case report of pathology-proven brain infection by Mycobacterium chimaera (MC). A 35-year-old male, previously operated in 2010 of aortic valve and ascending aortic replacement, was addressed to our hospital for the acute onset of aphasia preceded by absence. Computed tomography (CT) and magnetic resonance imaging (MRI) revealed multiple left frontal and temporal cortical-subcortical lesions. During hospitalization the patient never presented fever and cerebrospinal fluid (CSF), PCR, FilmArray and blood tests were within normal ranges. Transesophageal echocardiography showed no cardiac abnormalities. A thorax-abdomen CT scan was performed, revealing no extracranial abnormalities, and a whole body PET-CT scan showed a high uptake of brain lesions. Considering clinical results and the suspect of a tumoural lesion, the patient underwent surgery, where a left frontal enhanced nodular lesion was removed. Pathology finally revealed it was an abscess caused by Mycobacterium chimaera. This case confirms that Mycobacterium chimaera infection spread can be very subtle and diagnosis a real challenge, particularly years after surgery. We would like to underline the importance of suspecting an atypical infection source related to a history of cardiothoracic surgery, given a non-specific MR pattern and subtle clinical and laboratory findings.
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