title: Concomitant presentation of a glioblastoma multiforme with superimposed abscess.
abstract: BACKGROUND
  The coexistence of a primary brain tumor such as high-grade glioma and superimposed abscess is a rare entity and can present a diagnostic and therapeutic challenge. The concomitant abscess may not be recognized until surgery, and the overall course of treatment may require adjustment in the presence of a coinciding infection. In the present report we evaluate the diagnosis and treatment of a glioblastoma multiforme with an intratumoral abscess.
  
  
  METHODS
  A patient was diagnosed with a glioblastoma multiforme with a concomitantly superimposed multimicrobial abscess containing coagulase-negative Staphylococcus, Acinetobacter iwofii, and Propionibacterium species. The suspected infectious source was a dental abscess with presumed secondary seeding. The patient underwent a left anterior temporal lobectomy with debulking of the lesion. Although the adjuvant therapy schedule was adjusted to accommodate the course of antibiotics, the existence of a concurrent abscess did not preclude adjuvant radiation and chemotherapy.
  
  
  RESULTS
  The patient responded well to antibiotic treatment with no evidence of recurrent infection. He underwent a second operation for additional debulking of the lesion approximately half a year after his initial surgery. The patient died 2 years after the initial diagnosis.
  
  
  CONCLUSIONS
  There are insufficient guidelines on the treatment of a primary brain tumor with intratumoral abscess. In this report we present our therapeutic decisions in this rare case.
authors.affiliation: Neurosurgery Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: David H
authors.initials: DH
authors.lastname: Jho
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Spiliopoulos
authors.forename: Thor D
authors.initials: TD
authors.lastname: Stein
authors.forename: Ziv
authors.initials: Z
authors.lastname: Williams
mesh_terms: D001922:Brain Abscess / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D001932:Brain Neoplasms / Q000150:complications* / Q000175:diagnosis* / Q000382:microbiology; D020806:Central Nervous System Bacterial Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D003937:Diagnosis, Differential; D017809:Fatal Outcome; D005909:Glioblastoma / Q000150:complications* / Q000175:diagnosis* / Q000382:microbiology; D006801:Humans; D008297:Male; D008875:Middle Aged