{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T01:00:16Z","timestamp":1790125216585,"version":"4.0.1"},"reference-count":24,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"12","license":[{"start":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T00:00:00Z","timestamp":1789948800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Neurosurg Case Lessons"],"published-print":{"date-parts":[[2026,9,21]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>\n                      Brain abscess rarely presents with hemorrhagic transformation. Invasive\n                      <jats:italic>Klebsiella pneumoniae<\/jats:italic>\n                      syndrome (IKPS) is characterized by hematogenous dissemination from a primary hepatic focus, causing metastatic infections in various organs. The authors report a rare case of hemorrhagic brain abscess mimicking an intracranial neoplasm in the setting of IKPS managed with stereotactic drainage.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBSERVATIONS<\/jats:title>\n                    <jats:p>\n                      A 56-year-old male with a history of intra-abdominal surgery presented with progressive right-sided hemiparesis. CT performed at the referring hospital revealed a ring-enhancing lesion in the left basal ganglia consistent with a brain abscess. Repeat CT performed at the authors\u2019 institution showed a new intracavitary hemorrhage. Stereotactic aspiration yielded blood-tinged purulent material that grew\n                      <jats:italic>K. pneumoniae<\/jats:italic>\n                      ; blood cultures exhibited negative results. Systemic workup confirmed disseminated IKPS with liver, spine, psoas muscle, and urinary tract involvement. Two stereotactic drainage procedures were required, with significant reduction of the abscess following the second procedure.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>LESSONS<\/jats:title>\n                    <jats:p>\n                      Hemorrhagic brain abscess can radiologically mimic an intracranial neoplasm, particularly when hemorrhage complicates typical imaging features. Disseminated\n                      <jats:italic>K. pneumoniae<\/jats:italic>\n                      infection may occur despite negative blood cultures. Stereotactic drainage is safe and effective, and serial imaging is crucial for detecting reaccumulation and guiding repeat intervention.\n                    <\/jats:p>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/thejns.org\/doi\/10.3171\/CASE26593\">https:\/\/thejns.org\/doi\/10.3171\/CASE26593<\/jats:ext-link>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/case26593","type":"journal-article","created":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T00:00:38Z","timestamp":1789516838000},"source":"Crossref","is-referenced-by-count":0,"title":["Hemorrhagic brain abscess mimicking an intracranial neoplasm in invasive Klebsiella pneumoniae syndrome: illustrative case"],"prefix":"10.3171","volume":"12","author":[{"given":"Yugo","family":"Suzuki","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Tsukuba Memorial Hospital, Kaname, Tsukuba, Ibaraki"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kiyoyuki","family":"Yanaka","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Tsukuba Memorial Hospital, Kaname, Tsukuba, Ibaraki"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saaya","family":"Maruyama","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Tsukuba Memorial Hospital, Kaname, Tsukuba, Ibaraki"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2144-663X","authenticated-orcid":true,"given":"Toshihide","family":"Takahashi","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Tsukuba Memorial Hospital, Kaname, Tsukuba, Ibaraki"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nobuhiro","family":"Kishi","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Tsukuba Memorial Hospital, Kaname, Tsukuba, Ibaraki"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hitoshi","family":"Aiyama","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Tsukuba Memorial Hospital, Kaname, Tsukuba, Ibaraki"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nobuyuki","family":"Takahashi","sequence":"additional","affiliation":[{"name":"Department of Radiology, Tsukuba Memorial Hospital, Kaname, Tsukuba, Ibaraki"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7172-7608","authenticated-orcid":true,"given":"Aiki","family":"Marushima","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Institute of Medicine, University of Tsukuba, Tennodai, Tsukuba, Ibaraki, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eiichi","family":"Ishikawa","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Institute of Medicine, University of Tsukuba, Tennodai, Tsukuba, Ibaraki, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"4","key":"bib1","series-title":"Cureus","first-page":"e82744","article-title":"Cerebral abscess mimicking intracerebral hemorrhage: a case report","volume":"17","author":"Batol","year":"2025","unstructured":"Batol PAIVillaraza SG.Cerebral abscess mimicking intracerebral hemorrhage: a case report. Cureus. 2025;17(4):e82744. doi:10.7759\/cureus.82744"},{"issue":"8","key":"bib2","series-title":"Childs Nerv Syst","first-page":"481","article-title":"Spontaneous haemorrhage associated with a brain abscess","volume":"9","author":"Devi","year":"1993","unstructured":"Devi BIBhatia SKak VKBantwal S.Spontaneous haemorrhage associated with a brain abscess. Childs Nerv Syst. 1993;9(8):481-482. doi:10.1007\/BF00393556"},{"issue":"6","key":"bib3","series-title":"Neuroradiology","first-page":"565","article-title":"T2*-weighted MR angiography substantially increases the detection of hemorrhage in the wall of brain abscess: implications in clinical interpretation","volume":"54","author":"Gupta","year":"2012","unstructured":"Gupta RKTomar VAwasthi RT2*-weighted MR angiography substantially increases the detection of hemorrhage in the wall of brain abscess: implications in clinical interpretation. Neuroradiology. 2012;54(6):565-572. doi:10.1007\/s00234-011-0952-1"},{"issue":"3","key":"bib4","series-title":"Br J Neurosurg","first-page":"231","article-title":"Spontaneous haemorrhage in a cerebellar abscess: a unique complication","volume":"4","author":"Jamjoom","year":"1990","unstructured":"Jamjoom ABAtasoy MCoakham HB.Spontaneous haemorrhage in a cerebellar abscess: a unique complication. Br J Neurosurg. 1990;4(3):231-235. doi:10.3109\/02688699008992729"},{"issue":"1","key":"bib5","series-title":"Pediatr Neurosurg","first-page":"65","article-title":"Hemorrhage into the brain abscess cavity with Fallot\u2019s tetralogy","volume":"42","author":"Kaplan","year":"2006","unstructured":"Kaplan MTopsakal CCihangiroglu M.Hemorrhage into the brain abscess cavity with Fallot\u2019s tetralogy. Pediatr Neurosurg. 2006;42(1):65-66. doi:10.1159\/000089514"},{"key":"bib6","series-title":"World Neurosurg","first-page":"692.e17","article-title":"Hemorrhagic cerebellar abscess","volume":"88","author":"Laviv","year":"2016","unstructured":"Laviv YAlterman R.Hemorrhagic cerebellar abscess. World Neurosurg. 2016;88:692.e17-692.e22. doi:10.1016\/j.wneu.2015.12.039"},{"issue":"6","key":"bib7","series-title":"Neuroradiology","first-page":"576","article-title":"Brain abscess with hemorrhage","volume":"29","author":"Orita","year":"1987","unstructured":"Orita TFujii MHayashi MFudaba HAoki H.Brain abscess with hemorrhage. Neuroradiology. 1987;29(6):576-577. doi:10.1007\/BF00350446"},{"issue":"12","key":"bib8","series-title":"Cureus","first-page":"e32479","article-title":"Klebsiella pneumoniae brain abscess in a patient with chronic lymphocytic leukemia","volume":"14","author":"Rajavel","year":"2022","unstructured":"Rajavel ASadiq WWaleed MSEl-Sayegh D.Klebsiella pneumoniae brain abscess in a patient with chronic lymphocytic leukemia. Cureus. 2022;14(12):e32479. doi:10.7759\/cureus.32479"},{"key":"bib9","series-title":"Eurorad","article-title":"Brain abscess with haemorrhagic transformation","author":"Robinson","year":"2005","unstructured":"Robinson GGoulding J.Brain abscess with haemorrhagic transformation. Eurorad. 2005. doi:10.26044\/ecr2005\/C-0927"},{"issue":"3","key":"bib10","series-title":"Neuroradiology","first-page":"218","article-title":"MRI demonstration of haemorrhage in the wall of a brain abscess: possible implications for diagnosis and management","volume":"43","author":"Sudhakar","year":"2001","unstructured":"Sudhakar KVAgrawal SRashid MRHussain NHussain MGupta RK.MRI demonstration of haemorrhage in the wall of a brain abscess: possible implications for diagnosis and management. Neuroradiology. 2001;43(3):218-222. doi:10.1007\/s002340000467"},{"issue":"11","key":"bib11","series-title":"Neurol Med Chir (Tokyo)","first-page":"516","article-title":"Magnetic resonance imaging of brain abscess with hemorrhage: implications for the mechanism of hemorrhage","volume":"47","author":"Terakawa","year":"2007","unstructured":"Terakawa YTakami TYamagata TSaito TNakanishi N.Magnetic resonance imaging of brain abscess with hemorrhage: implications for the mechanism of hemorrhage. Neurol Med Chir (Tokyo). 2007;47(11):516-518. doi:10.2176\/nmc.47.516"},{"key":"bib12","series-title":"Case Rep Radiol","first-page":"907584","article-title":"Hemorrhage in the wall of pyogenic brain abscess on susceptibility weighted MR sequence: a report of 3 cases","volume":"2014","author":"Thamburaj","year":"2014","unstructured":"Thamburaj KAgarwal AKSabat SBNguyen DT.Hemorrhage in the wall of pyogenic brain abscess on susceptibility weighted MR sequence: a report of 3 cases. Case Rep Radiol. 2014;2014:907584. doi:10.1155\/2014\/907584"},{"issue":"6","key":"bib13","series-title":"Rinsho Shinkeigaku","first-page":"372","article-title":"A case of cerebral putaminal hemorrhage complicating a brain abscess proved by craniotomy","volume":"44","author":"Umezawa","year":"2004","unstructured":"Umezawa RIsozumi KKomatsumoto SFukuuchi YInaba M.A case of cerebral putaminal hemorrhage complicating a brain abscess proved by craniotomy. Article in Japanese. Rinsho Shinkeigaku. 2004;44(6):372-374."},{"issue":"2","key":"bib14","series-title":"Neurocrit Care","first-page":"428","article-title":"Asymptomatic brain abscess with intracerebral hemorrhage","volume":"31","author":"Yoon","year":"2019","unstructured":"Yoon EJHa SWKang HG.Asymptomatic brain abscess with intracerebral hemorrhage. Neurocrit Care. 2019;31(2):428-431. doi:10.1007\/s12028-019-00690-y"},{"issue":"10","key":"bib15","series-title":"Arch Intern Med","first-page":"1913","article-title":"Klebsiella pneumoniae liver abscess associated with septic endophthalmitis","volume":"146","author":"Liu","year":"1986","unstructured":"Liu YCCheng DLLin CL.Klebsiella pneumoniae liver abscess associated with septic endophthalmitis. Arch Intern Med. 1986;146(10):1913-1916. doi:10.1001\/archinte.1986.00360220057011"},{"issue":"11","key":"bib16","series-title":"Lancet Infect Dis","first-page":"881","article-title":"Klebsiella pneumoniae liver abscess: a new invasive syndrome","volume":"12","author":"Siu","year":"2012","unstructured":"Siu LKYeh KMLin JCFung CPChang FY.Klebsiella pneumoniae liver abscess: a new invasive syndrome. Lancet Infect Dis. 2012;12(11):881-887. doi:10.1016\/S1473-3099(12)70205-0"},{"issue":"6","key":"bib17","series-title":"J Neurosurg","first-page":"972","article-title":"Clinical stages of human brain abscesses on serial CT scans after contrast infusion. Computerized tomographic, neuropathological, and clinical correlations","volume":"59","author":"Britt","year":"1983","unstructured":"Britt RHEnzmann DR.Clinical stages of human brain abscesses on serial CT scans after contrast infusion. Computerized tomographic, neuropathological, and clinical correlations. J Neurosurg. 1983;59(6):972-989. doi:10.3171\/jns.1983.59.6.0972"},{"issue":"1","key":"bib18","series-title":"J Clin Invest","first-page":"349","article-title":"Astrocytes are the primary source of tissue factor in the murine central nervous system. A role for astrocytes in cerebral hemostasis","volume":"92","author":"Eddleston","year":"1993","unstructured":"Eddleston Mde la Torre JCOldstone MBLoskutoff DJEdgington TSMackman N.Astrocytes are the primary source of tissue factor in the murine central nervous system. A role for astrocytes in cerebral hemostasis. J Clin Invest. 1993;92(1):349-358. doi:10.1172\/JCI116573"},{"issue":"6","key":"bib19","series-title":"Am J Pathol","first-page":"1299","article-title":"Development and characterization of an experimental model of brain abscess in the rat","volume":"141","author":"Flaris","year":"1992","unstructured":"Flaris NAHickey WF.Development and characterization of an experimental model of brain abscess in the rat. Am J Pathol. 1992;141(6):1299-1307."},{"issue":"9","key":"bib20","series-title":"Neurology","first-page":"806","article-title":"Clinical characteristics and outcome of brain abscess: systematic review and meta-analysis","volume":"82","author":"Brouwer","year":"2014","unstructured":"Brouwer MCCoutinho JMvan de Beek D.Clinical characteristics and outcome of brain abscess: systematic review and meta-analysis. Neurology. 2014;82(9):806-813. doi:10.1212\/WNL.0000000000000172"},{"issue":"6","key":"bib21","series-title":"Neurosurg Focus","first-page":"E2","article-title":"Pyogenic brain abscess","volume":"24","author":"Erdo\u011fan","year":"2008","unstructured":"Erdo\u011fan ECansever T.Pyogenic brain abscess. Neurosurg Focus. 2008;24(6):E2. doi:10.3171\/FOC\/2008\/24\/6\/E2."},{"issue":"6","key":"bib22","series-title":"J Neurosurg","first-page":"852","article-title":"Significance of hemorrhage into brain tumors: clinicopathological study","volume":"67","author":"Kondziolka","year":"1987","unstructured":"Kondziolka DBernstein MResch LSignificance of hemorrhage into brain tumors: clinicopathological study. J Neurosurg. 1987;67(6):852-857. doi:10.3171\/jns.1987.67.6.0852"},{"issue":"4","key":"bib23","series-title":"Clin Infect Dis","first-page":"763","article-title":"Brain abscess","volume":"25","author":"Mathisen","year":"1997","unstructured":"Mathisen GEJohnson JP.Brain abscess. Clin Infect Dis. 1997;25(4):763-79. doi:10.1086\/515541"},{"issue":"3","key":"bib24","series-title":"Clin Microbiol Rev","first-page":"e00001-19","article-title":"Hypervirulent Klebsiella pneumoniae","volume":"32","author":"Russo","year":"2019","unstructured":"Russo TAMarr CM.Hypervirulent Klebsiella pneumoniae. 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