Actinomycotic Brain Abscess Developed 10 Years after Head Trauma

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/ by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Actinomyces species are members of the endogenous flora of mucous membranes, and are frequently cultured from the gas-trointestinal tract, bronchi, and female genital tract. Infections due to Actinomyces are usually associated with the breakdown of normal physical barriers, such as disruption of mucosal membranes in the mouth and gastrointestinal tract. The major sites of actinomycoses are cervicofacial, abdominopelvic, and thoracic sites, where it usually presents with the development of an abscess , a draining sinus tract, fistulae, and tissue fibrosis. 1 Less common sites of actinomycotic infection include the central nervous system (CNS) and musculoskeletal soft tissue. In Ko-rea, only two cases of CNS actinomycoses have been reported. 2,3 Herein, we report a rare case of CNS actinomycosis that caused a cerebral abscess. A healthy 45-year-old man presented with 3 days of left-sided weakness, left-sided facial palsy, and dysarthria. His medical history was remarkable for a laceration head injury 10 years prior. He received a surgical suture and was admitted to the intensive care unit because mild intracranial hemorrhage was identified. He recovered with conservative management and the injury did not leave any neurologic sequelae. The patient and his family denied having any history of heavy alcohol consumption, dental carries, cancer, diabetes mellitus, or surgery on orofacial, thoracic, or abdominal areas. Physical examination revealed that the patient was drowsy but well oriented and afebrile. Laboratory examinations showed a white blood cell count of 9,900/ mm 3 with a differential count of 68% segmented cells and 23% lymphocytes. The erythrocyte sedimentation rate was 18 mm/ hr and the C-reactive protein was 0.3 mg/dL. The initial non-enhanced brain computed tomography demonstrated a 3.5×2.5 cm irregular mass in the right frontal lobe with severe perile-sional edema. Brain magnetic resonance imaging showed that the lesion was hypointense on a T1-weighted image and hyper-intense on a T2-weighted image, with thick and irregular ring-like enhancement. A diffusion weighted image demonstrated high signal intensity, reflecting restricted diffusion (Fig. 1). For a definite diagnosis and treatment, the patient underwent open surgery and the mass was excised along with surrounding brain parenchyma. Grossly, the specimen included an abscess cavity containing yellowish green pus, surrounded by a thick fibrous capsule. Histological examination showed …