Introduction: Streptococcus species most commonly causes bacterial brain abscesses. Streptococcal pneumoniae is the most common cause of bacterial meningitis in adults. However, Streptococcus pneumoniae accounts for less than 1% of all bacterial brain abscesses. We describe a unique case of streptococcus pneumoniae brain abscess in an infant

Methods: Case report

Case Description: A 9-month-old, former 36 week late preterm, previously healthy infant presented to our hospital with acute right sided facial twitch that started two weeks prior to presentation. Blood work was unremarkable. Brain Computerized Tomography was consistent with numerous enhancing brain lesions with associated left cerebral vasogenic edema.

Magnetic resonance imaging (MRI) demonstrated multiple intra-axial ring enhancing masses in both cerebral hemispheres, intraventricular mass in right temporal horn, multiple hemorrhagic brain masses, and suspected left fronto parietal abscess.

Results: Patient underwent left frontoparietal craniotomy with abscess drainage that grew streptococcus pneumoniae serotype 33F. Treatment course was complicated by left axillary and basilic vein thrombosis as well as cytopenias, particularly neutropenia. Interestingly, immunophenotyping of patient’s bone marrow was initially thought to be consistent with B lymphoblastic leukemia, but later concluded to be in favor of increased hematogones suggestive of congenital neutropenia. Patient continued antibiotic course and was recovering well at the time of discharge.

Conclusions: Streptococcal pneumoniae brain abscess remain an uncommon presentation of bacterial brain abscess. A high index of suspicion for underlying congenital heart defects or immune deficiencies should be pursued in patients with unclear etiologies. Management includes a combination of antibiotics and surgical drainage.