Multiple cerebral abscess caused by Klebsiella pneumonia on post tumor excision procedure

Abstract

A cerebral abscess can happen due to a nearby brain infection, other rare body parts spread, head injury and surgery procedures. Intracranial Klebsiella pneumoniae infection rarely happens and usually occurs in immunocompromised patients. We reported a case of a 50 years old immunocompetent woman with prior tumor excision that progressed to a cerebral abscess. The patient came to the ER unconscious with progressive right-side weakness, pus from previous operation scar, fever and headache since few days’ pre-admission. Laboratory findings were leukocyte 13.710, neutrophil 9%, CRP 7.6, and negative HIV test. The contrast CT scan resulted in a multiloculated ring enhancement left frontal lobe lesion sized 5.8x6.9x5.0 cm and perifocal oedema. Open craniotomy managed to evacuate ±40cc. The microbiology culture tested positive for Klebsiella pneumoniae. Despite proper technique and administration of prophylaxis antibiotics, severe infection that requires immediate intervention still develops in a small group of patients. Klebsiella pneumoniae is a common pathogen causing cerebral abscess in both immunocompromised and healthy patients. Pus drainage and immediate antibiotics administration improved all symptoms, including hemiparesis. This case highlights the importance of quick and right therapy.