Spontaneous Cerebral Pyoventriculitis Caused by Pantoea agglomerans: case report and literature review

Resumo

A pioventriculite caracteriza-se pelo empiema intraventricular. Geralmente é secundária à meningite, ao abscesso cerebral rompido ou a procedimentos neurocirúrgicos e apresenta elevada mortalidade. Apresentamos o caso de um paciente de 3 meses com história de aumento significativo do perímetro cefálico nos últimos 30 dias. Investigação inicial com tomografia computadorizada de crânio evidenciou dilatação dos ventrículos laterais com conteúdo denso intraventricular. Na sequência realizou-se punção transfontanelar com drenagem de secreção purulenta. A análise da secreção coletada evidenciou hipercelularidade e no exame cultural observou-se o crescimento de Pantoea agglomerans. A investigação complementar com ressonância magnética de crânio com gadolínio corroborou com o diagnóstico de pioventriculite biventricular associado a múltiplas malformações cerebrais. A investigação de TORCHs revelou a presença de citomegalovírus no líquido cefalorraquidiano e na urina. O paciente manteve o tratamento antimicrobiano e antiviral por 8 semanas com resposta satisfatória. O caso relatado evidencia um paciente com malformações cerebrais congênitas, provavelmente secundárias à infecção intrauterina pelo citomegalovírus. As malformações cerebrais propiciaram um ambiente favorável à neuroinfecção, a qual se concentrou em ambos os ventrículos laterais, sem disseminação para o parênquima, cistos adjacentes e demais espaços liquóricos. O patógeno causador da infecção raramente causa infecções em humanos. Na literatura, há apenas 2 casos de acometimento do sistema nervoso central por Pantoea agglomerans, ambos após um procedimento neurocirúrgico. Nessa perspectiva, apresentamos um caso único de ventriculite espontânea, adquirida na comunidade por uma bactéria que, até então, não havia sido associada com tal patologia.

Palavras-chave

Ventriculite cerebral; Pantoea; Infecções por citomegalovírus

Abstract

Pyoventriculitis is characterized by intraventricular empyema. It is usually secondary to meningitis, ruptured brain abscess, or neurosurgical procedures and has a high mortality rate. We present the case of a 3-month-old patient with a history of significant increase in head circumference. Initial investigation with cranial computed tomography showed dilation of the lateral ventricles with dense intraventricular content. Subsequently, transfontanellar puncture was performed with purulent discharge drainage. Analysis of the collected discharge showed hypercellularity, and the culture examination showed the growth of Pantoea agglomerans. Complementary investigation with cranial magnetic resonance imaging with gadolinium corroborated the diagnosis of biventricular pyoventriculitis associated with multiple brain malformations. TORCH investigation revealed the presence of cytomegalovirus in cerebrospinal fluid and urine. The reported case highlights a patient with congenital brain malformations, probably secondary to intrauterine cytomegalovirus infection. Brain malformations provided a favorable environment for neuroinfection, which was concentrated in both lateral ventricles. The pathogen causing the infection rarely causes infections in humans. In the literature, there are only 2 cases of central nervous system involvement by Pantoea agglomerans, both after a neurosurgical procedure. Therefore, we present a unique case of spontaneous ventriculitis, acquired in the community by a bacterium that, until today, had not been associated with such pathology.

Keywords

Cerebral ventriculitis; Pantoea; Cytomegalovirus infections

References

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Spontaneous Cerebral Pyoventriculitis Caused by Pantoea agglomerans: case report and literature review

Pioventriculite Cerebral Espontâneo por Pantoea agglomerans: relato de caso e revisão da literatura

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JBNC Brazilian Journal of Neurosurgery

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