Brain Abscess Due to Streptococcus Anginosus After Professional Dental Cleaning

A 30-year-old male patient with no preexisting diseases presented to our emergency department due to right-sided headache and photophobia. Cranial magnetic resonance imaging (cMRI) identified a mass measuring approximately 4 cm in diameter in the right frontal operculum with pronounced perifocal edema and midline shift consistent with a brain abscess. Calculated antimicrobial therapy with flucloxacillin, ceftriaxone, and metronidazole was administered, and microsurgical abscess evacuation via craniotomy was performed. Molecular genetic and culture investigations of abscess material yielded evidence of Streptococcus anginosus, whereupon antimicrobial therapy was switched to penicillin G and metronidazole. A rapid clinical improvement was observed in the further course. Diagnostic investigations of the surrounding area by means of transesophageal echocardiography and abdominal computed tomography revealed no further sites of infection. When questioned, the patient reported having undergone professional dental cleaning 3 weeks previously. Given that S. anginosus makes up part of the physiological oral flora, it is highly likely that bacteremia occurring during dental cleaning was causal in the development of the brain abscess.

Figure

Brain abscess with perifocal edema on contrast-enhanced MRI (a) and in a FLAIR (fluid attenuated inversion recovery) sequence (b)

Dr. med. Thomas Theo Brehm, Sektion Infektiologie, I. Medizinische Klinik und Poliklinik, Universitätsklinikum Hamburg-Eppendorf, [e-mail]

PD Dr. med. Fabian Flottmann, Klinik und Poliklinik für Neuroradiologische Diagnostik und Intervention, Universitätsklinikum Hamburg-Eppendorf

PD Dr. med. Lasse Dührsen, Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Hamburg-Eppendorf

Conflict of interest statement:The authors declare that no conflict of interest exists.

Translated from the original German by Christine Rye.

Cite this as: Brehm TT, Flottmann F, Dührsen L: Brain abscess due to Streptococcus anginosus after professional dental cleaning.
Dtsch Arztebl Int 2023; 120: 13a. DOI: 10.3238/arztebl.m2022.0262