Brain Tumor Research and Treatment

The Korean Brain Tumor Society (대한뇌종양학회)
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Brain Abscess Showing a Lack of Restricted Diffusion and Successfully Treated with Linezolid

  • Kim, Joo-hyun (Department of Neurosurgery, Eulji University, Nowon Eulji Medical Center) ;
  • Park, Sang-phil (Department of Neurosurgery, Eulji University, Nowon Eulji Medical Center) ;
  • Moon, Byung-gwan (Department of Neurosurgery, Eulji University, Nowon Eulji Medical Center) ;
  • Kim, Deok-ryeong (Department of Neurosurgery, Eulji University, Nowon Eulji Medical Center)
  • Received : 2018.06.29
  • Accepted : 2018.09.28
  • Published : 2018.10.31
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Abstract

A 59-year-old patient with a history of hepatocellular carcinoma presented with decreased consciousness and left hemiparesis. A rim-enhanced mass lesion without diffusion restriction was observed in contrast-enhanced MRI including diffusion-weighted imaging. Based on these findings, metastatic brain tumor was suspected. However, brain abscess (BA) was diagnosed after multiple bacterial colonies were observed in aspiration biopsy. Initial conventional antibiotic treatment including vancomycin had failed, so linezolid was used as second-line therapy. As a result, infection signs and clinical symptoms were resolved. We report a case with atypical imaging features and antibiotic susceptibility of a BA in an immunocompromised patient undergoing chemotherapy.

Keywords

References

  1. Brouwer MC, Tunkel AR, van de Beek D. Brain abscess. N Engl J Med 2014;371:1758.
  2. Nathoo N, Nadvi SS, Narotam PK, van Dellen JR. Brain abscess: management and outcome analysis of a computed tomography era experience with 973 patients. World Neurosurg 2011;75:716-26; discussion 612-7. https://doi.org/10.1016/j.wneu.2010.11.043
  3. Britt RH, Enzmann DR, Yeager AS. Neuropathological and computerized tomographic findings in experimental brain abscess. J Neurosurg 1981;55:590-603. https://doi.org/10.3171/jns.1981.55.4.0590
  4. Brouwer MC, Coutinho JM, van de Beek D. Clinical characteristics and outcome of brain abscess: systematic review and meta-analysis. Neurology 2014;82:806-13. https://doi.org/10.1212/WNL.0000000000000172
  5. Xu XX, Li B, Yang HF, et al. Can diffusion-weighted imaging be used to differentiate brain abscess from other ring-enhancing brain lesions? A meta-analysis. Clin Radiol 2014;69:909-15. https://doi.org/10.1016/j.crad.2014.04.012
  6. Birmingham MC, Rayner CR, Meagher AK, Flavin SM, Batts DH, Schentag JJ. Linezolid for the treatment of multidrug-resistant, grampositive infections: experience from a compassionate-use program. Clin Infect Dis 2003;36:159-68. https://doi.org/10.1086/345744
  7. Helweg-Larsen J, Astradsson A, Richhall H, Erdal J, Laursen A, Brennum J. Pyogenic brain abscess, a 15 year survey. BMC Infect Dis 2012;12:332. https://doi.org/10.1186/1471-2334-12-332
  8. Muzumdar D, Jhawar S, Goel A. Brain abscess: an overview. Int J Surg 2011;9:136-44. https://doi.org/10.1016/j.ijsu.2010.11.005
  9. Xiao F, Tseng MY, Teng LJ, Tseng HM, Tsai JC. Brain abscess: clinical experience and analysis of prognostic factors. Surg Neurol 2005;63:442-9; discussion 449-50. https://doi.org/10.1016/j.surneu.2004.08.093
  10. Erdogan E, Cansever T. Pyogenic brain abscess. Neurosurg Focus 2008;24:E2.
  11. Goodkin HP, Harper MB, Pomeroy SL. Intracerebral abscess in children: historical trends at Children's Hospital Boston. Pediatrics 2004;113:1765-70. https://doi.org/10.1542/peds.113.6.1765
  12. Yuh WT, Nguyen HD, Gao F, et al. Brain parenchymal infection in bone marrow transplantation patients: CT and MR findings. AJR Am J Roentgenol 1994;162:425-30. https://doi.org/10.2214/ajr.162.2.8310939
  13. Ozbayrak M, Ulus OS, Berkman MZ, Kocagoz S, Karaarslan E. Atypical pyogenic brain abscess evaluation by diffusion-weighted imaging: diagnosis with multimodality MR imaging. Jpn J Radiol 2015;33:668-71. https://doi.org/10.1007/s11604-015-0472-8
  14. Reddy JS, Mishra AM, Behari S, et al. The role of diffusion-weighted imaging in the differential diagnosis of intracranial cystic mass lesions: a report of 147 lesions. Surg Neurol 2006;66:246-50; discussion 250-1. https://doi.org/10.1016/j.surneu.2006.03.032
  15. Nath K, Agarwal M, Ramola M, et al. Role of diffusion tensor imaging metrics and in vivo proton magnetic resonance spectroscopy in the differential diagnosis of cystic intracranial mass lesions. Magn Reson Imaging 2009;27:198-206. https://doi.org/10.1016/j.mri.2008.06.006
  16. Toh CH, Wei KC, Chang CN, et al. Differentiation of pyogenic brain abscesses from necrotic glioblastomas with use of susceptibility-weighted imaging. AJNR Am J Neuroradiol 2012;33:1534-8. https://doi.org/10.3174/ajnr.A2986
  17. Pal D, Bhattacharyya A, Husain M, Prasad KN, Pandey CM, Gupta RK. In vivo proton MR spectroscopy evaluation of pyogenic brain abscesses: a report of 194 cases. AJNR Am J Neuroradiol 2010;31:360-6. https://doi.org/10.3174/ajnr.A1835
  18. Livermore DM. Linezolid in vitro: mechanism and antibacterial spectrum. J Antimicrob Chemother 2003;51 Suppl 2:ii9-16. https://doi.org/10.1093/jac/dkg050
  19. Vinh DC, Rubinstein E. Linezolid: a review of safety and tolerability. J Infect 2009;59 Suppl 1:S59-74. https://doi.org/10.1016/S0163-4453(09)60009-8
  20. French G. Safety and tolerability of linezolid. J Antimicrob Chemother 2003;51 Suppl 2:ii45-53. https://doi.org/10.1093/jac/dkg020

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