Fusobacterium brain abscess as a complication of sinusitis in an immunocompetent adolescent: A case report

Table 1 Investigations done in the referring hospital and in our institute

Parameter	Referring hospital	Our institute
Total count (cells/µL)	17000	13400
Neutrophils (%)	56	87
CRP (mg/L)/ESR (mm/hour)	92/-	113/50
Urea (mg/dL)/creatinine (mg/dL)	26/0.5	35/0.87
CSF protein (mg/dL)	88	-
CSF sugar (mg/dL)	40	-
CSF cells (/µL)	496	114
CSF GeneXpert	Negative	Negative
CSF culture	No growth	No growth
Pus culture	Not done	No growth
Blood culture	No growth	No growth
16S rRNA (NGS) from pus	Not done	Fusobacterium nucleatum

CRP: C-reactive protein; ESR: Erythrocyte sedimentation rate; CSF: Cerebrospinal fluid; NGS: Next-generation sequencing.

Table 2 Pediatric cases of Fusobacterium brain abscess in different clinical settings

Ref.	Age/sex	Risk factors	Findings (organism and imaging)	Treatment and outcome
Multiple brain abscesses and bacteremia (Meis et al[11], 1993)	6 years/female	Recent Mycoplasma pneumoniae infection	Fusobacterium necrophorum; multiple brain abscesses	Penicillin G + metronidazole × 2 months → complete recovery
Brain abscess after intraoral laceration (Ochi et al[12], 2020)	9 years/female	Cyanotic CHD; intraoral trauma	Fusobacterium nucleatum + others; single abscess (15 mm × 10 mm) in left internal capsule with edema	Craniotomy drainage + ceftriaxone × 8 weeks → good recovery
Unusual neurological presentation (Haddad et al[13], 2016)	2 years/female	Tonsillitis; delayed treatment	Fusobacterium necrophorum; multiple cerebral abscesses + subdural empyema	Meropenem × 6 weeks + surgery → favorable outcome
Current case (present report)	15 years/male	Acute bacterial sinusitis; immunocompetent	Fusobacterium nucleatum; bilateral frontal subdural abscess with empyema	Burr-hole drainage + ceftriaxone + metronidazole × 4 weeks → full recovery

CHD: Congenital heart disease.