Stenotrophomonas maltophilia-associated odontogenic cerebral abscess in an immunocompetent patient: A case report

Abstract

Key clinical message: Stenotrophomonas maltophilia can cause rare odontogenic brain abscesses in immunocompetent patients, highlighting the importance of considering uncommon pathogens in central nervous system infections. With only three reported cases of cerebral abscesses and one pituitary abscess caused by this microorganism, tailored diagnostic methods and individualized treatment regimens are crucial for accurate management.

Abstract: Brain abscesses present diagnostic and therapeutic challenges, with Stenotrophomonas maltophilia infections being exceptionally rare in the central nervous system. We present a case of odontogenic brain abscesses caused by S. maltophilia in an immunocompetent patient, highlighting the rarity and complexity of such infections. A 66-year-old male presented with spatial-temporal disorientation and left-sided weakness. Radiological investigations revealed an expansive lesion in the right posterior frontal region. A craniotomy and drainage were performed, identifying S. maltophilia in the purulent material. The patient responded well to tailored antibiotic therapy. S. maltophilia-related central nervous system infections are infrequent, emphasizing the need for a heightened clinical suspicion in atypical cases. This case contributes to the literature, emphasizing the importance of a multidisciplinary approach for successful diagnosis and management.

Keywords: Stenotrophomonas maltophilia; brain abscess; immunocompetent; multidisciplinary approach; odontogenic infection.

FIGURE 1

Preoperative axial T1‐weighted MRI with gadolinium revealing a hypointense lesion in the right posterior frontal region with peripheral contrast enhancement (A). Axial and sagittal T2‐weighted images confirm the presence of an expansive lesion in the right posterior frontal region. The lesion exhibits significant hyperintensity in the perilesional white matter on T2 images, suggesting vasogenic edema and mass effect on adjacent structures (B).

FIGURE 2

In the culture plate image, colonies representing Stenotrophomonas maltophilia were observed on MacConkey Agar, specific for gram‐negative bacteria, after 24 h; the colonies appeared morphologically homogeneous.

FIGURE 3

One‐month postoperative brain MRI images revealed a significant reduction in the volume of the lesion within the right frontal cortico‐subcortical region, indicating complete resolution. Additionally, there was nearly complete disappearance of enhancement along the margins after gadolinium administration.