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Case Reports
. 2023 Aug 17;15(8):e43647.
doi: 10.7759/cureus.43647. eCollection 2023 Aug.

Peculiar Case of Brain Abscess Caused by Propionibacterium acnes in an Immunocompetent Individual Without Prior Neurosurgical Intervention: A Case Report and Literature Review

Muhammad Tahir  1 , Mary Vansant  2 , Osama Elkadi  1
Affiliations
Case Reports

Peculiar Case of Brain Abscess Caused by Propionibacterium acnes in an Immunocompetent Individual Without Prior Neurosurgical Intervention: A Case Report and Literature Review

Muhammad Tahir et al. Cureus. .

Abstract

Propionibacterium acnes (P. acnes) is a slow-growing, anaerobic, gram-positive bacillus that commonly colonizes the skin and is a rare cause of CNS infections. It was previously viewed as a culture contaminant but is now recognized to infrequently cause indolent cases of CNS infections. It is even more rarely associated with abscesses in patients without a prior history of neurosurgical intervention. Due to being a slow-growing bacteria, P. acnes is frequently discovered to be the causative organism after 16S rRNA sequencing. In this case, the culture was positive. There are only five other reported cases of patients with a P. acnes abscess without prior neurosurgical intervention. Here we present the sixth case of an immunocompetent young male who was found to have a P. acnes brain abscess.

Keywords: anaerobic brain abscess; brain abscess excision; brain infection; propionibacterium; propionibacterium acnes.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. A) MRI with intravenous gadolinium showed a lesion with significant vasogenic edema and midline shift; B) Post-craniotomy MRI showing residual lesion.
Figure 2
Figure 2. Low-power view showing minute fragments of necrotic debris and a few atypical glial cells (A, 4x; B, 10x). High-power view showing predominantly necrotic debris (C, 20x; D, 40x).
Figure 3
Figure 3. Low-power view showing multiple fragments of necrotic brain parenchyma (A, B, C 4x). Medium and high-power showing fragments of necrotic tissue with macrophages and perivascular inflammatory infiltrate (D, 10x; E, 20x; F, 40x).
Figure 4
Figure 4. CD3 highlights scattered T lymphocytes (A, 4x). CD34 is focally positive in endothelial cells (B, 4x). CD68 is diffusely positive and highlights the macrophages (C, 4x). The CMV stain is negative (D, 4x). GFAP is diffusely positive, showing reactive gliosis (E, 4x). GMS is negative for microorganisms (F, 4x).
CMV: cytomegalovirus; GFAP: glial fibrillary acidic protein; GMS: Grocott methenamine silver
Figure 5
Figure 5. Negative HSV and Ki-67 (A, B, 4x). PASH+D is negative for fungal-like organisms (C, 4x). Negative AFB for Mycobacterium tuberculosis (D, 4x). Gram stain negative for bacteria (E, 4x). Negative Toxoplasma immunostaining (F, 4x).
HSV: herpes simplex virus; PAS: periodic acid-Schiff; PAS-D: periodic acid-Schiff with diastase; AFB: acid-fast bacilli
Figure 6
Figure 6. Culture media showing growth of Propionibacterium acnes.
See this image and copyright information in PMC

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