A case of hospital-acquired GNB infection - P. aeruginosa meningoencephalitis post laparoscopic cholecystectomy for biliary pancreatitis, complicated with portal vein branch thrombosis and intracerebral ischemic and hemorrhagic lesions
© Rogoz et al; licensee BioMed Central Ltd. 2014
Published: 15 October 2014
Pseudomonas aeruginosa infections involving the CNS usually present as meningitis or brain abscesses. The CNS invasion is the result of direct inoculation (head trauma, surgery), spread from a distant site (urinary, abdominal infections) or by direct invasion of a contiguous structure (inner ear, head sinus).
We present the case of a female patient admitted to our clinic with a suspicion of acute bacterial meningoencephalitis, one month after a laparoscopic cholecystectomy. During the first 48 hours she presented generalized seizures, 5-6 daily, with a duration that ranged from 30 to 60 seconds, that responded to medical therapy. The CSF cultures and the pulmonary tract secretions both tested positive for P. aeruginosa. The antibiotic regimen consisted of iv meropenem, colistin and ciprofloxacin for 7 days, then meropenem and ciprofloxacin for 21 days. The evolution and the treatment decisions were complicated by the discovery on the cerebral MRI of bilateral frontal ischemic and hemorrhagic lesions and a portal vein branch thrombosis.
The patient registered almost complete cognitive and motor recovery, and is continuing the kinetotherapy.
This P. aeruginosa isolate had a resistance profile that permitted the use of antibiotics with good CNS penetration, which proved a decisive factor in the therapeutic success.
Written informed consent was obtained from the patient for publication of this Case report and any accompanying images. A copy of the written consent is available for review by the Editor of this journal.
This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.