A Rare Case of Brain Abscess Due to Streptococcus Constellatus Following Pneumonia and Empyema in a Young Immunocompetent Male

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Journal of Investigative Medicine





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Case report Streptococcus constellatus is a regular commensal of the oral cavity and is known to cause pyogenic infections. We present an interesting case of an immunocompetent male found to have a brain abscess and pneumonia with empyema due S. constellatus. A 17 year-old male with well-controlled type 2 diabetes mellitus and history of pneumonia with empyema due to Streptococcus intermedius treated with antibiotics and video assisted thoracoscopic surgery (VATS) 2 years prior, presented to the emergency department (ED) with acute onset of altered mental status. Imaging performed in the ED was suggestive of brain abscess (figure 1a) and pneumonia with empyema (figure 1b). S.constellatus was isolated from the pleural fluid and from the brain abscess. The patient was started on appropriate antimicrobial therapy. Studies, including an echocardiogram and nuclear scan of the body, did not show any other focus of infection. Immunodeficiency was excluded by normal T-cell subsets, immunoglobulin assay and complement studies. Other infectious, inflammatory and neoplastic etiologies were excluded as well. Very few cases of brain abscesses caused by S. Constellatus have been reported in the literature. Only one case in an immunocompetent patient has been reported to date. Recurrent pleural effusions at the same pleural space, associated with an intracranial abscess, due to S. constellatus, in an immunocompetent individual makes our case unique. This unexpected presentation demonstrates the necessity of timely surgical debridement with appropriate intravenous antibiotics to treat pyogenic infections caused by this common commensal bacteria.


Medicine and Health Sciences



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