Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
권호 표지
DOI QR코드

DOI QR Code

Gas-Forming Brain Abscess Caused by Klebsiella Pneumoniae

  • Cho, Keun-Tae (Department of Neurosurgery, Dongguk University Ilsan Hospital) ;
  • Park, Bong-Jin (Department of Neurosurgery, Kyung Hee University Hospital)
  • Published : 2008.12.31
Download PDF
⟨ Previous Next ⟩

Abstract

Gas forming brain abscess is a rare disease caused by Klebsiella pneumoniae occurring in patients with impaired host defense mechanism such as diabetes mellitus or liver cirrhosis. A 59-year-old man with 2-year history of diabetes mellitus and 20-year history of liver cirrhosis presented to the hospital with headache. On the day after admission, severe headache was developed and he deteriorated rapidly. Brain CT showed a non-enhanced mass including multiple air density as well as surrounding edema seen in the right occipital lobe, and isodensity air-fluid level seen in the right lateral ventricle. Despite emergent ventricular drainage and intraventricular and intravenous administration of antibiotics, his condition progressively worsened to sepsis and to death after 5 days. Bacterial culture of blood and ventricular fluids disclosed a Gram (-) rod, Klebsiella pneumoniae. In this report we review the pathogenic mechanism and its management.

Keywords

References

  1. Azar-Kia B, Sarwar M, Batnitzky S, Schechter M : Radiology of intracranial gas. Am J Roentgenol Radium Ther Nucl Med 124 : 315-323, 1975 https://doi.org/10.2214/ajr.124.2.315
  2. Beller AJ, Sahar A, Praiss I : Brain abscess. Review of 89 cases over a period of 30 years. J Neurosurg Psychiatry 36 : 757-768, 1973 https://doi.org/10.1136/jnnp.36.5.757
  3. Domingo Z : Clostridial brain abscesses. Br J Neurosurg 8 : 691- 694, 1994 https://doi.org/10.3109/02688699409101182
  4. Isono M, Wakabayashi Y, Nakano T, Fujiki M, Mori T. Hori S : Treatment of brain abscess associated with ventricular rupture-three case reports. Neurol Med Chir (ToKyo) 37 : 630-636, 1997 https://doi.org/10.2176/nmc.37.630
  5. Liliang PC, Hung KS, Cheng CH, Chen HJ, Ohta I, Lui CC : Rapid gas-forming brain abscess due to Klebsiella pneumoniae. J Neurosurg 91 : 1060, 1999 https://doi.org/10.3171/jns.1999.91.6.1060
  6. Liliang PC, Lin YC, Su TM, Rau CS, Lu CH, Chang WN, et al : Klebsiella brain abscess in adults. Infection 29 : 81-86, 2001 https://doi.org/10.1007/s15010-001-0069-2
  7. Mathisen GE, Johnson JP : Brain abscess. Clin Infect Dis 25 : 763-779; quiz 780-781, 1997 https://doi.org/10.1086/515541
  8. Norrell H, Howieson J : Gas-containing brain abscesses. Am Roentgenol Radium Ther Nucl Med 109 : 273-276, 1970 https://doi.org/10.2214/ajr.109.2.273
  9. Rau CS, Chang WN, Lin YC, Liliang PC, Su TM, Tsai YD, et al : Brain abscess caused by aerobic Gram-negative bacilli : clinical features and therapeutic outcomes. Clin Neurol Neurosurg 105 : 60- 65, 2002 https://doi.org/10.1016/S0303-8467(02)00103-8
  10. Rosenblum ML, Hoff JT, Norman D, Weinstein PR, Pitts L : Decreased mortality from brain abscesses since advent of computerized tomography. J Neurosurg 49 : 658-668, 1978 https://doi.org/10.3171/jns.1978.49.5.0658
  11. Taguchi Y, Sato J, Nakamura N : Gas-containing brain abscess due to Fusobacterium nucleatum. Surg Neurol 16 : 408-410, 1981 https://doi.org/10.1016/0090-3019(81)90231-7
  12. Takeshita M, Kawamata T, Izawa M, Hori T : Prodromal signs and clinical factors influencing outcome in patients with intraventricular rupture of purulent brain abscess. Neurosurgery 48 : 310-316; discussion 316-317, 2001 https://doi.org/10.1097/00006123-200102000-00012
  13. Yang SY : Brain abscess : a review of 400 cases. J Neurosurg 55 : 794- 799, 1981 https://doi.org/10.3171/jns.1981.55.5.0794
  14. Yang SY, Zhao CS : Review of 140 patients with brain abscess. Surg Neurol 39 : 290-296, 1993 https://doi.org/10.1016/0090-3019(93)90008-O
  15. Young RF, Frazee J : Gas within intracranial abscess cavities : an indication for surgical excision. Ann Neurol 16 : 35-39, 1984 https://doi.org/10.1002/ana.410160108
  16. Zeidman SM, Geisler FH, Olivi A : Intraventricular rupture of a purulent brain abscess : case report. Neurosurgery 36 : 189-193; discussion 193, 1995 https://doi.org/10.1227/00006123-199501000-00026

Cited by

  1. Rapidly Progressive Gas-containing Lumbar Spinal Epidural Abscess vol.12, pp.3, 2008, https://doi.org/10.14245/kjs.2015.12.3.139
  2. Esophageal pneumatosis in the setting of small bowel ileus with acute resolution after nasogastric tube decompression vol.12, pp.3, 2017, https://doi.org/10.1016/j.radcr.2017.03.001
  3. Retrospective study on clonal relationship of multidrug-resistant Klebsiella spp. indicates closed circulation and initiation of clonal divergence vol.67, pp.5, 2008, https://doi.org/10.1099/jmm.0.000715