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

Background

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).

Case report

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.

Conclusion

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.

Consent

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.