Disseminated Cerebritis With Myelitis By Propionibacterium Acnes In Healthy Elderly Female (P2.314)

Abstract

BACKGROUND: Propionibacterium acnes (P. acnes) is a Gram positive, anaerobic bacillus that is a part of the normal human skin flora and involved in the development of acnes vulgaris. Reportedly, infections of the central nervous system (CNS) by P. acnes are rare and have been strongly associated with neurosurgical procedures. We present a case of acute cerebritis with cervical myelitis by P. acnes without any past neurosurgical procedures, in which the histopathological diagnosis was confirmed by biopsy. CASE REPORT: A 75-year-old woman was admitted for left-sided hemiparesis. She did not have any significant medical histories. Laboratory tests were normal, but serologic tests for syphilis were positive. Initial brain magnetic resonance imaging (MRI) revealed multiple small masses with rim enhancement that restricted diffusion with T2 hyperintensities in the both frontal cortex and the right internal capsule. As the first impression was multiple brain metastases, diagnostic work-ups were performed to look for the primary malignancy. Examination of the cerebrospinal fluid (CSF) was normal. Because intensive work-up did not show any malignancy, we performed whole body positron emission tomography and which showed suggested malignant lesion in the spinal cord of C3-5 level. Cervical MRI revealed intramedullary enhancement lesion associated with cord swelling at the same level. On histopathologic examination of the lesion by brain biopsy, there was no evidence of malignancy. Localized collection of foamy histiocytes with perivascular lymphocytic infiltration was observed with Gram-positive filamentous branching hyphae. DNA sequencing results were entirely consistent with P. acnes. After treating with empirical antibiotics, her symptoms were improving. Follow-up brain and cervical MRI demonstrated markedly decreased size of prior multiple lesions. DISCUSSION: Characteristically, P. acnes presents as an indolent infection and microbiological identification is complicated. There were few reports of CNS infection in adults without any previous surgical procedures, and they had been limited to brain lesions. To our knowledge, this is the first case of acute cerebritis with myelitis by P. acnes.

Disclosure: Dr. Lee has nothing to disclose. Dr. Heo has nothing to disclose. Dr. Chang has nothing to disclose. Dr. Lee has nothing to disclose. Dr. Bu has nothing to disclose.