Case Report: Pediatric pontine abscess and ecthyma gangrenosum due to Pseudomonas aeruginosa septicemia
Brainstem abscesses are remarkably rare, with only a few reports in the pediatric literature. Their presence portends high morbidity and mortality and most commonly present in the setting of immunodeficiency. A 5-year-old boy with a history of recurrent acute otitis media presented to the emergency...
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Frontiers Media S.A.
2025-01-01
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| Series: | Frontiers in Pediatrics |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fped.2025.1449357/full |
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| author | Jonathan Theros Madison Wolfe Larry Kociolek Larry Kociolek Irini N. Kolaitis Irini N. Kolaitis |
| author_facet | Jonathan Theros Madison Wolfe Larry Kociolek Larry Kociolek Irini N. Kolaitis Irini N. Kolaitis |
| author_sort | Jonathan Theros |
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| description | Brainstem abscesses are remarkably rare, with only a few reports in the pediatric literature. Their presence portends high morbidity and mortality and most commonly present in the setting of immunodeficiency. A 5-year-old boy with a history of recurrent acute otitis media presented to the emergency department with rash, otorrhea, confusion, and fever. He was found to be in septic shock secondary to Pseudomonas aeruginosa bacteremia; a skin exam revealed multifocal ecthyma gangrenosum. He was initially treated with intravenous ceftazidime. Despite adequate antibiotic coverage he had persistent fevers. Whole-body magnetic resonance imaging revealed an expansile pontine mass; dedicated neuroimaging confirmed a 10 mm pontine abscess. Given the lack of neurological deficits on examination, he was treated non-operatively with intravenous cefepime for 9 weeks followed by oral levofloxacin for 30 days and made a nearly complete clinical recovery. Extensive immunodeficiency workup did not identify an immunologic defect. Prompt action through interdisciplinary care meetings and avoidance of early diagnostic closure resulted in an excellent neurological outcome for this patient with this rare case of a P. aeruginosa brainstem abscess. |
| format | Article |
| id | doaj-art-fde668cb80154a9b96b60d0382a63fde |
| institution | Kabale University |
| issn | 2296-2360 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Pediatrics |
| spelling | doaj-art-fde668cb80154a9b96b60d0382a63fde2025-01-29T06:46:03ZengFrontiers Media S.A.Frontiers in Pediatrics2296-23602025-01-011310.3389/fped.2025.14493571449357Case Report: Pediatric pontine abscess and ecthyma gangrenosum due to Pseudomonas aeruginosa septicemiaJonathan Theros0Madison Wolfe1Larry Kociolek2Larry Kociolek3Irini N. Kolaitis4Irini N. Kolaitis5The Feinberg School of Medicine, Northwestern University, Chicago, IL, United StatesAnn & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, United StatesThe Feinberg School of Medicine, Northwestern University, Chicago, IL, United StatesAnn & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, United StatesThe Feinberg School of Medicine, Northwestern University, Chicago, IL, United StatesAnn & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, United StatesBrainstem abscesses are remarkably rare, with only a few reports in the pediatric literature. Their presence portends high morbidity and mortality and most commonly present in the setting of immunodeficiency. A 5-year-old boy with a history of recurrent acute otitis media presented to the emergency department with rash, otorrhea, confusion, and fever. He was found to be in septic shock secondary to Pseudomonas aeruginosa bacteremia; a skin exam revealed multifocal ecthyma gangrenosum. He was initially treated with intravenous ceftazidime. Despite adequate antibiotic coverage he had persistent fevers. Whole-body magnetic resonance imaging revealed an expansile pontine mass; dedicated neuroimaging confirmed a 10 mm pontine abscess. Given the lack of neurological deficits on examination, he was treated non-operatively with intravenous cefepime for 9 weeks followed by oral levofloxacin for 30 days and made a nearly complete clinical recovery. Extensive immunodeficiency workup did not identify an immunologic defect. Prompt action through interdisciplinary care meetings and avoidance of early diagnostic closure resulted in an excellent neurological outcome for this patient with this rare case of a P. aeruginosa brainstem abscess.https://www.frontiersin.org/articles/10.3389/fped.2025.1449357/fullbrainstem abscesspseudomonasecthyma gangrenonsumpontine abscessimmunodeficiencysepsis |
| spellingShingle | Jonathan Theros Madison Wolfe Larry Kociolek Larry Kociolek Irini N. Kolaitis Irini N. Kolaitis Case Report: Pediatric pontine abscess and ecthyma gangrenosum due to Pseudomonas aeruginosa septicemia Frontiers in Pediatrics brainstem abscess pseudomonas ecthyma gangrenonsum pontine abscess immunodeficiency sepsis |
| title | Case Report: Pediatric pontine abscess and ecthyma gangrenosum due to Pseudomonas aeruginosa septicemia |
| title_full | Case Report: Pediatric pontine abscess and ecthyma gangrenosum due to Pseudomonas aeruginosa septicemia |
| title_fullStr | Case Report: Pediatric pontine abscess and ecthyma gangrenosum due to Pseudomonas aeruginosa septicemia |
| title_full_unstemmed | Case Report: Pediatric pontine abscess and ecthyma gangrenosum due to Pseudomonas aeruginosa septicemia |
| title_short | Case Report: Pediatric pontine abscess and ecthyma gangrenosum due to Pseudomonas aeruginosa septicemia |
| title_sort | case report pediatric pontine abscess and ecthyma gangrenosum due to pseudomonas aeruginosa septicemia |
| topic | brainstem abscess pseudomonas ecthyma gangrenonsum pontine abscess immunodeficiency sepsis |
| url | https://www.frontiersin.org/articles/10.3389/fped.2025.1449357/full |
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