title: Pediatric brainstem abscess with hemorrhage mimicking diffuse intrinsic pontine glioma: a case report.
abstract: OBJECTIVE
  We report a rare case of brainstem abscess with hemorrhage mimicking diffuse intrinsic pontine glioma (DIPG).
  
  
  METHODS
  A 7-month-old baby girl presented with lethargy and poor oral feeding. She had the mild fever for 1 month. Brain computed tomography revealed the hypodense lesion in the pons. Brain magnetic resonance images (MRI) showed around 1.4-cm-sized rim-enhanced mass with perilesional edema and internal hemorrhage in the pons. The cerebral blood volume was increased in the rim-enhanced area. The provisional diagnosis was DIPG, but the mass did not show the expansile mass with encasement of the basilar artery on the ventral pons.
  
  
  RESULTS
  The biopsy was done via the floor of the fourth ventricle, and the pathologic findings showed the many inflammatory cells and CD68-immunopositive macrophage which were compatible with abscess. The antibiotics with ceftriaxone and metronidazole were administrated for 11 weeks, and the follow-up MRI showed the slightly small enhanced lesion without central necrotic area. Three years later, follow-up MRI revealed the encephalomalacic change and atrophy of the pons. She had the stable neurologic deficit of left facial palsy and right hemiparesis.
  
  
  CONCLUSIONS
  The biopsy could be necessary for pontine lesions without typical radiologic findings of DIPG.
authors.affiliation: Department of Neurosurgery, Chonnam National University Medical School, Gwangju, Republic of Korea.
authors.forename: Ju-Hwi
authors.initials: JH
authors.lastname: Kim
authors.affiliation: Department of Neurosurgery, Chonnam National University Medical School, Gwangju, Republic of Korea. jung-ty@chonnam.ac.kr.|Department of Neurosurgery, Chonnam National University Hwasun Hospital, 160, Ilsim-ri, Hwasun-eup, Hwasun-gun, Jeollanam-do, 519-809, Republic of Korea. jung-ty@chonnam.ac.kr.
authors.forename: Tae-Young
authors.initials: TY
authors.lastname: Jung
authors.affiliation: Department of Neurosurgery, Chonnam National University Medical School, Gwangju, Republic of Korea.
authors.forename: Seung-Hoon
authors.initials: SH
authors.lastname: Jung
authors.affiliation: Department of Pathology, Chonnam National University Hwasun Hospital, Gwangju, Republic of Korea.
authors.forename: Kyung-Hwa
authors.initials: KH
authors.lastname: Lee
authors.affiliation: Department of Radiology, Chonnam National University Hospital, Gwangju, Republic of Korea.
authors.forename: Seul-Kee
authors.initials: SK
authors.lastname: Kim
mesh_terms: D015703:Antigens, CD / Q000378:metabolism; D015214:Antigens, Differentiation, Myelomonocytic / Q000378:metabolism; D001922:Brain Abscess / Q000150:complications* / Q000473:pathology*; D001933:Brain Stem / Q000473:pathology*; D020295:Brain Stem Neoplasms / Q000503:physiopathology*; D005260:Female; D005910:Glioma / Q000503:physiopathology*; D006470:Hemorrhage / Q000150:complications*; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging; D000097382:CD68 Molecule
chemical_list: D015703:Antigens, CD; D015214:Antigens, Differentiation, Myelomonocytic; C067980:CD68 antigen, human; D000097382:CD68 Molecule
keywords: Abscess; Diffuse; Glioma; Pediatric; Pons