Multiple large brain abscesses in a newborn that may have resulted from intrauterine infection

Headnote

SUMMARY: Çelik IH, Demirel G, Erdeve Ö, Uras N, Dilmen U. Multiple large brain abscesses in a newborn that may have resulted from intrauterine infection. Turk J Pediatr 2011; 53: 561-566.

Brain abscess is a focal, intracerebral infection that begins as a localized area of cerebritis and develops into a collection of pus surrounded by a well-vascularized capsule. Here, we report a case with multiple, large brain abscesses diagnosed coincidentally on postnatal day 11. This case is noteworthy because the organized abscesses were present as early as day 11 with no significant neurological signs or symptoms.

Brain abscess in newborns is a very rare disease that may not exhibit the expected neurological signs and symptoms. Depending on the radiological organization, an abscess in a neonate in the first weeks may be the result of an intrauterine infection.

Key words: brain abscess, intrauterine infection, newborn.

Brain abscess is a rare complication of neonatal meningitis that occurs in 1-4% of all cases5'6. It is a focal, intracerebral infection that begins as a localized area of cerebritis and develops into a collection of pus surrounded by a well-vascularized capsule. Early capsulation is seen in 10-13 days7. Surgical drainage may be used to treat a brain abscess, but it has become less common. Early diagnosis using radiological modalities such as ultrasonography (USG), computed tomography (CT), magnetic resonance imaging (MRI), and microbiological techniques together with more effective antibiotics have improved treatment8. However, the mortality and morbidity rates for neonatal brain abscess remain high, especially following ventricular perforation. An immature immune system, inability to isolate the infection and susceptibility to infection may contribute to the high mortality and morbidity rates in neonates1,9.

The clinical signs of a brain abscess are generally non-specific, and the diagnosis is often coincidental. A microbiological agent cannot be identified in all cases; a negative culture is reported in up to 30% of the cases7. Early diagnosis and treatment of brain abscess are essential because of the related high mortality and morbidity.

Here, we report a case with multiple, large brain abscesses diagnosed coincidentally on postnatal day 11. This case is noteworthy because the organized abscesses were present as early as day 11 with no significant neurological signs or symptoms.

Case Report

The subject was...