Brain abscess due to Arcanobacterium haemolyticum after dental extraction.

Brain Abscess Due to Arcanobacterium haemolyticum after Dental Extraction To the Editor—It has been suggested that 5%–20% of brain abscesses are presumably associated with oral infections or dental procedures [1–4], in which organisms belonging to the oropharyngeal flora, such as Arcanobacterium haemolyticum, are involved [5, 6]. This organism has been documented in cases of pharyngitis and wound infections [7], but rarely in systemic infections [7–9] and even less in brain abscesses [10]. We describe the case of a patient who developed a brain abscess due to A. haemolyticum infection after undergoing dental extraction procedure. An 18-year-old man without a remarkable medical history, except for repeated periodontal manipulations, was admitted to the hospital with headache, vomiting, aphasia, weakness in his left extremities, behavior and mood alterations, and fever. Three months before admission, he had been treated for periodontitis and dental caries in a primary dental clinic. He underwent extraction of multiple teeth. He had been well until 15 days before hospital admission, when intense headache and vomiting developed. Seven days before hospitalization, weakness in his left extremities became worse, and he was unable to stand or walk. A brain CT scan revealed a left-sided hypodense fronto-parietal le-sion with cystic, contrast ring enhancement and perilesional edema exerting a significant mass effect (a 1.8-cm displacement of the middle line). He was referred to our hospital and was admitted to a neu-rosurgical ward. On admission to the neu-rosurgical ward, he was afebrile. His blood pressure was 140/80 mmHg, his respiratory rate was 14 breaths per min, his heart rate was 82 beats per min, and his temperature was 36.6ЊC. He was conscious and alert. Neurologic examination revealed no evidence of neck stiffness or of Kernig's or Brudzinski's signs. Muscle strength was 3/5 in his left leg muscle and in his left forearm muscle. Laboratory data included a peripheral WBC count of cells/L with 88% neutro-9 19.02 ϫ 10 phils, a hemoglobin level of 13.3 g/dL, a platelet count of platelets/L, 9 304 ϫ 10 and an erythrocyte sedimentation rate of 10 mm/h. His aspartate aminotransfer-ase, alanine aminotransferase, anaplastic lymphoma kinase, creatinine, blood glucose , plasma sodium, and plasma potassium levels were normal. Subaracnoid hemorrhage was suspected as the likely diagnosis. He was treated with supportive care, but continued to complain of symptoms he had at admission. On his second day in the hospital, he complained of severe headache, and his mental state abruptly became …