A case of neonatal Proteus mirabilis meningitis with multiple brain abscesses

• Published in: Nervous System in Children Vol. 47; no. 4; pp. 389 - 394
• Main Authors: Matsuura, So, Utsugi, Reina, Arita, Hideyuki, Maeno, Kazushige, Yabumoto, Kanako, Saito, Taeko, Onishi, Satoshi, Ishimori, Shingo, Okizuka, Yo, Harada, Atsuko
• Format: Journal Article
• Language: Japanese
• Published: The Japanese Society for Pediatric Neurosurgery 2022
• Subjects: brain abscess; meningitis; neonatal; neuronavigation - assisted drainage; Proteus mirabilis
• ISSN: 0387-8023; 2435-824X
• DOI: 10.34544/jspn.47.4_389

Proteus mirabilis (PM) is a gram-negative bacillus belonging to the family Enterobacteriaceae. Bacterial meningitis caused by PM is associated with cerebral abscesses and has a poor prognosis. We report a case of a 28-day-old boy with PM meningitis with multiple brain abscesses whose condition improved after antimicrobial and surgical treatment. He developed fever and poor feeding at the age of four days, and was diagnosed with bacterial meningitis caused by PM and treated with antibiotic. Head magnetic resonance imaging revealed multiple brain abscesses, which tended to expand. Therefore, the patient was transferred to our hospital for multidisciplinary treatment. At 30 days of age, neuronavigation-assisted drainage of the abscesses was conducted on three abscesses that did not communicate with the ventricles. Surgical treatment was not conducted on the abscesses that communicated with the ventricles in order to not increase the risk of spreading to ventricular inflammation. After that, the infection of the brain abscess subsided, but hydrocephalus developed and required ventricular peritoneal shunting. The boy is now two years and one month old. Head magnetic resonance images show that the ventricles are shrinking, but his development is moderately delayed. Approximately half of the patients with PM brain abscesses die, and even surviving patients often have severe sequelae. This case was predicted to have a poor prognosis due to the causative bacteria, multiple brain abscesses, and abscesses communicating with the ventricles. However, we succeeded in improving the PM brain abscess without complicating ventriculitis due to accurate evaluation of the state of disease and appropriate multidisciplinary treatment. When treating PM meningitis, it is important to be careful with potential complications of brain abscesses and conduct appropriate surgical treatment early based on clinical symptoms and image evaluation.