{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,2]],"date-time":"2026-11-02T17:56:35Z","timestamp":1793642195814,"version":"4.5.1"},"reference-count":9,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2020,7,21]],"date-time":"2020-07-21T00:00:00Z","timestamp":1595289600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2020,7,21]],"date-time":"2020-07-21T00:00:00Z","timestamp":1595289600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Med Case Reports"],"published-print":{"date-parts":[[2020,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n<jats:title>Background<\/jats:title>\n<jats:p>Brain abscesses are relatively rare, but they are a potentially life-threatening condition. Predictive factors for poor outcome are a young age and the presence of multiple abscesses. We report a case of a 15-month-old girl with cyanotic congenital heart disease who developed multiple brain abscesses caused by <jats:italic>Streptococcus intermedius.<\/jats:italic> The patient was treated with a combination of surgical aspiration and antimicrobial therapy without apparent neurological sequelae. To the best of our knowledge, this is the youngest such patient to have been reported in the literature. We explore the possible causes of her good outcome.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Case presentation<\/jats:title>\n<jats:p>At the age of 15\u2009months, the Japanese patient initially was presented to our hospital with transient eye deviation to the left and vomiting. In a blood examination, her white blood cell count (12,720 per mm<jats:sup>3<\/jats:sup> with a left shift) and C-reactive protein level (1.23\u2009mg\/ml) were slightly elevated. Magnetic resonance imaging of the brain showed three mass lesions. These were 1.5-cm, 1.9-cm, and 1.2-cm rim-enhancing lesions with extensive surrounding edema. Brain abscesses were diagnosed, and vancomycin (50\u2009mg every 12\u2009hours) and meropenem (40\u2009mg every 8\u2009hours) were started empirically. However, because each brain abscess was enlarged at 8\u2009days after admission, surgical aspiration was performed at 10\u2009days after admission, and cultures of the aspirated pus grew <jats:italic>S. intermedius<\/jats:italic>. Penicillin G (0.7 million units every 4\u2009hours) and ceftriaxone (280\u2009mg every 12\u2009hours), to which this isolate is susceptible, were then administered, and the brain abscesses reduced in size. After 1\u2009month of ceftriaxone and 3\u2009months of penicillin G treatment, all of the brain abscesses disappeared. Apparent neurological sequelae were not observed at 6\u2009months after onset.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>A good outcome can be obtained if multiple brain abscesses develop in infancy or early childhood in cases without unconsciousness at admission, meningitis, or sepsis. Appropriate antimicrobial therapy should be started immediately after diagnosis, with surgical aspiration performed to identify the causative pathogen and avoid intraventricular rupture of the brain abscesses.<\/jats:p>\n<\/jats:sec>","DOI":"10.1186\/s13256-020-02436-3","type":"journal-article","created":{"date-parts":[[2020,7,20]],"date-time":"2020-07-20T23:08:05Z","timestamp":1595286485000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Multiple brain abscesses with good prognosis in an infant with cyanotic congenital heart disease: a case report"],"prefix":"10.1186","volume":"14","author":[{"given":"Atsuko","family":"Kudo-Kubo","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuichi","family":"Shimakawa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yutaka","family":"Odanaka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naokado","family":"Ikeda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hikaru","family":"Kitahara","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiromitsu","family":"Toshikawa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Atsuko","family":"Ashida","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miho","family":"Fukui","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noriyasu","family":"Ozaki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kanta","family":"Kishi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masahiko","family":"Wanibuchi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akira","family":"Ashida","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2020,7,21]]},"reference":[{"key":"2436_CR1","doi-asserted-by":"publisher","first-page":"1","DOI":"10.3171\/FOC\/2008\/24\/6\/E8","volume":"24","author":"JL Frazier","year":"2008","unstructured":"Frazier JL, Ahn ES, Jallo GI. Management of brain abscesses in children. Neurosurg Focus. 2008;24:1\u201310.","journal-title":"Neurosurg Focus"},{"key":"2436_CR2","first-page":"603","volume":"56","author":"T Ghafoor","year":"2006","unstructured":"Ghafoor T, Amin MU. Multiple brain abscesses in a child with congenital cyanotic heart disease. J Pak Med Assoc. 2006;56:603\u20135.","journal-title":"J Pak Med Assoc"},{"key":"2436_CR3","doi-asserted-by":"publisher","first-page":"129","DOI":"10.1097\/INF.0b013e3182748d6e","volume":"32","author":"S Felsenstein","year":"2013","unstructured":"Felsenstein S, Williams B, Shingadia D, Coxon L, Riordan A, Demetriades AK, et al. Clinical and microbiologic features guiding treatment recommendations for brain abscesses in children. Pediatr Infect Dis J. 2013;32:129\u201335.","journal-title":"Pediatr Infect Dis J"},{"key":"2436_CR4","doi-asserted-by":"publisher","first-page":"1163","DOI":"10.1111\/j.1651-2227.2010.01780.x","volume":"99","author":"Y Shachor-Meyouhas","year":"2010","unstructured":"Shachor-Meyouhas Y, Bar-Joseph G, Guilburd JN, Lorber A, Hadash A, Kassis I. Brain abscess in children \u2013 epidemiology, predisposing factors and management in the modern medicine era. Acta Paediatr. 2010;99:1163\u20137.","journal-title":"Acta Paediatr"},{"key":"2436_CR5","doi-asserted-by":"publisher","first-page":"447","DOI":"10.1056\/NEJMra1301635","volume":"371","author":"MC Brouwer","year":"2014","unstructured":"Brouwer MC, Tunkel AR, McKhann GM 2nd, van de Beek D. Brain abscess. N Engl J Med. 2014;371:447\u201356.","journal-title":"N Engl J Med"},{"key":"2436_CR6","doi-asserted-by":"publisher","first-page":"1765","DOI":"10.1542\/peds.113.6.1765","volume":"113","author":"HP Goodkin","year":"2004","unstructured":"Goodkin HP, Harper MB, Pomeroy SL. Intracerebral abscess in children: historical trends at Children\u2019s Hospital Boston. Pediatrics. 2004;113:1765\u201370.","journal-title":"Pediatrics."},{"key":"2436_CR7","doi-asserted-by":"publisher","first-page":"309","DOI":"10.1007\/s003810050400","volume":"15","author":"AV Ciurea","year":"1999","unstructured":"Ciurea AV, Stoica F, Vasilescu G, Nuteanu L. Neurosurgical management of brain abscesses in children. Childs Nerv Syst. 1999;15:309\u201317.","journal-title":"Childs Nerv Syst"},{"key":"2436_CR8","doi-asserted-by":"publisher","first-page":"1270","DOI":"10.1097\/00006123-199712000-00006","volume":"41","author":"M Takeshita","year":"1997","unstructured":"Takeshita M, Kagawa M, Yato S, Izawa M, Onda H, Takakura K, et al. Current treatment of brain abscess in patients with congenital cyanotic heart disease. Neurosurgery. 1997;41:1270\u20139.","journal-title":"Neurosurgery."},{"key":"2436_CR9","doi-asserted-by":"publisher","first-page":"1","DOI":"10.3171\/jns.1972.36.1.0001","volume":"36","author":"ME Carey","year":"1972","unstructured":"Carey ME, Chou SN, French LA. Experience with brain abscesses. J Neurosurg. 1972;36:1\u20139.","journal-title":"J Neurosurg"}],"container-title":["Journal of Medical Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13256-020-02436-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s13256-020-02436-3\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13256-020-02436-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,7,20]],"date-time":"2021-07-20T23:32:17Z","timestamp":1626823937000},"score":1,"resource":{"primary":{"URL":"https:\/\/jmedicalcasereports.biomedcentral.com\/articles\/10.1186\/s13256-020-02436-3"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,7,21]]},"references-count":9,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2020,12]]}},"alternative-id":["2436"],"URL":"https:\/\/doi.org\/10.1186\/s13256-020-02436-3","relation":{},"ISSN":["1752-1947"],"issn-type":[{"value":"1752-1947","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,7,21]]},"assertion":[{"value":"22 April 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"8 June 2020","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"21 July 2020","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The need for approval was waived.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Written informed consent was obtained from the patient\u2019s family for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"111"}}