Occipital Brain Abscess with Obstructive Hydrocephalus Caused by Streptococcus anginosus in a 24-Year-Old Male: A Case Report
Abstract
Background: Brain abscesses are severe intracranial infections with significant morbidity and mortality. The Streptococcus anginosus group (SAG), known for its abscess-forming potential in deep tissues, rarely causes central nervous system (CNS) infections.
Case Presentation: We report a 24-year-old immunocompetent male presenting with high-grade fever, headache, vomiting, and confusion. Imaging revealed a right occipital lobe abscess with obstructive hydrocephalus. Cerebrospinal fluid culture grew S. anginosus, confirming the diagnosis. The patient underwent emergency insertion of an external ventricular drain and received empirical meropenem and vancomycin, later de-escalated to cefotaxime based on sensitivity testing. Follow-up imaging demonstrated complete abscess resolution after six weeks of antibiotic therapy.
Discussion: This case represents, to our knowledge, the first documented S. anginosus brain abscess in Saudi Arabia. The pathogen’s ability to produce tissue-invasive enzymes and biofilms contributes to its virulence. While streptococci are frequently isolated from brain abscesses in the region, species-level identification is often lacking, leading to underreporting of SAG-related infections. Early neuroimaging, microbiological identification, and combined surgical-antibiotic management are crucial for favorable outcomes.
Conclusion:S. anginosus should be considered a potential cause of brain abscesses, even in healthy individuals. Routine species-level microbiological analysis is essential for accurate diagnosis, targeted therapy, and improved epidemiological understanding.
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Copyright (c) 2025 Sirajo Tambuwal, Seriehan Mubarak Alshammari, Mubarak Alhumaidi Alshammari
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