title: Pontine abscess with initial treatment failure following infectious endocarditis with Streptococcus salivarius.
abstract: We present a case report of a 65-year-old man admitted to the department of infectious diseases on suspicion of meningitis with headache, fever and double vision. A cerebral MRI revealed a 17×30 mm pontine abscess with surrounding oedema. The patient had, 2 months prior to admission, been treated for Streptococcus salivarius aortic valve endocarditis. The abscess was not suitable for surgery, and the patient received multidrug antibiotic treatment for 4 weeks. The patient initially responded well clinically, but was readmitted 4 weeks after discontinuation of treatment, with headache and dizziness. A new cerebral MRI showed progression of the abscess. He received an additional 8 weeks of broad spectrum antibiotic treatment, followed by 12 weeks of oral treatment with pivampicillin. His symptoms resolved and a cerebral MRI at discontinuation of treatment showed regression of the abscess to 7.5 mm.
authors.affiliation: Department of Infectious Diseases, Odense University Hospital, Odense C, Denmark.
authors.forename: Fredrikke Christie
authors.initials: FC
authors.lastname: Knudtzen
authors.affiliation: Department of Radiology, Odense University Hospital, Odense C, Denmark.
authors.forename: Maja
authors.initials: M
authors.lastname: Lynge
authors.affiliation: Department of Infectious Diseases, Odense University Hospital, Odense C, Denmark.
authors.forename: Shahin
authors.initials: S
authors.lastname: Gaini
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001021:Aortic Valve; D000082882:Bicuspid Aortic Valve Disease; D001922:Brain Abscess / Q000188:drug therapy*; D004359:Drug Therapy, Combination; D004697:Endocarditis, Bacterial / Q000188:drug therapy*; D006330:Heart Defects, Congenital / Q000188:drug therapy; D006349:Heart Valve Diseases / Q000188:drug therapy; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D064847:Multimodal Imaging; D049268:Positron-Emission Tomography; D013290:Streptococcal Infections / Q000188:drug therapy*; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents