A girl of 2 months and 15 days whose mother consulted for irritation and increased skull perimeter.
Cerebral ultrasound was requested, which showed a heterogeneous image in the right frontoparietal lobe, with midline shift and collapse of the ipsilateral ventricle with mass effect.
Background: RNT/PAEG; birth weight was 3,190 g, height: 47.5 cm, HC: 35 cm (P 50); Apgar 7/10.
Vaginal delivery was admitted to the neonatal unit for suspected sepsis and respiratory distress for 3 days. Empirical antibiotic therapy (negative cultures) was indicated.
At one month of life she was admitted for 48 h due to febrile syndrome with morbilliform rash, which was interpreted as probable viral etiology.
Pathological cultures were negative.
He did not receive antibiotics.
After 15 days, the patient was operated on due to vomiting that resolved after modifying the feeding technique.
For a while her mother had been calling attention to the increase in her daughter's head size and the more abominated cutaneous manifestation; there was no fever or other associated symptoms.
In the health controls their weight at 17 days was: 3,200 g, height: 49 cm, HC: 36 cm (P 50); at 2 months weight: 4,460 g, height: 54,5 cm (CP: 40 cm).
On admission, the child presented irritability, hypertensive spontaneous speech, macrocephalia, preserved visual follow-up and slowed right photomotor reflex.
Weight: 5,130 g (p50), height: 55 cm (p75), HC: 42.5 cm (>P 97).
Vital signs: HR: 120 per min, RR: 26 per min, T: 36.7 °C.
The rest of the physical examination was within normal parameters.
Contrast-enhanced brain CT scan revealed a deep frontal corticosubcortical spherical lesion with a solid-cystic component that reinforced with the administration of contrast.
He also presented perilesional edema with contralateral hemispheric displacement.
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She underwent surgery due to suspicion of a brain tumor; on the cortical surface, cystic lesions were observed that opened and 45 ml of microscopic and purulent material were removed.
The intraoperative pathological report recorded reactive astrocytosis, which was interpreted as an infectious process (cerebral abscess).
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Empirical antibiotic therapy was indicated with ceftazidime, vancomycin and metronidazole for 6 weeks.
The abscess culture was positive for Citrobacter koseri, with negative culture of cerebrospinal fluid (CSF) and normal cytophysiochemical.
