POSTTRAUMATIC GAS-CONTAINING BRAIN-ABSCESS CAUSED BY CLOSTRIDIUM-PERFRINGENS WITH UNIQUE SIMULTANEOUS FUNGAL SUPPURATION BY MYCELIOPHTHORA-THERMOPHILA - CASE-REPORT

OBJECTIVE AND IMPORTANCE: Gas-containing brain abscesses are rare, and the vast majority are caused by Clostridium perfringens. Significant simultaneous fungal infection in a bacterial abscess is even rarer. We present such a case and review the literature. CLINICAL PRESENTATION: A 21-month-old male patient sustained a penetrating head injury in a barnyard, developed a gas-containing left parietal brain abscess, and presented with high fever, galeal swelling, and seizure. INTERVENTION: The patient initially underwent debridement of his wound and then rep eated aspirations. The initial cultures revealed pure growth of Clostr idium perfringens. Despite appropriate antibiotic therapy, serial neur oimaging did not demonstrate a decrease in the size of the cavity. An excision had to be undertaken 6 weeks after the injury. The culture fr om the excised specimen revealed an unexpected growth of a saprophytic and opportunistic fungus, Myceliophthora thermophila. Antifungal trea tment consisting of the administration of liposomal amphotericin B and itraconazole was then performed. The child was well and neurologicall y intact 6 months after the excision. CONCLUSION: Our review revealed 38 cases of clostridial brain abscess in the literature. Despite the r eputation of the organism, the outcome with clostridial brain abscesse s was relatively benign. The main characteristics of clostridial brain abscesses are highlighted, with reference to their optimal treatment. Our review also revealed that fungal infection after a penetrating he ad injury is extremely rare and often fatal. Our case seems to be the first in the medical literature with growth of M. thermophila as a cau sative agent for intracranial suppuration.