Introduction: Brain abscess is a life-threatening intracranial infection in children. It is a frequent complication of otitis media, meningitis, sinusitis, depressed immunity, contiguous site infection and less commonly, hematogenous. The site of affection depends on the source of infection. Streptococci are less commonly associated with basal ganglia abscesses in children and need early institution of appropriate antimicrobials.

Methods: We describe a 3-year girl with acute febrile encephalopathy and multiple, small, bilateral abscesses in the basal ganglia and thalami predominantly along the perforating branches of middle cerebral artery.

Results: Blood culture grew Streptococcus pneumoniae (sensitive to Vancomycin); cerebrospinal fluid culture was sterile. Magnetic resonance imaging of brain showed multiple small, discrete and confluent T2/FLAIR hyperintensities in bilateral basal ganglia and thalami with diffusion restriction and contrast enhancement suggestive of brain abscesses. Her immunoglobulin profile and absolute lymphocyte count were normal. She was administered intravenous vancomycin for 6 weeks. Repeat MRI showed significant regression in the size of abscesses and arrested hydrocephalous. At discharge, she had involuntary movements, hypotonia and minimal conscious state.

Conclusion: Brain abscesses are a rare complication of Streptococcus pneumoniae blood stream infection and need prolonged treatment with antimicrobials. Basal ganglia is an uncommon site of infection in the brain and results in disabling sequelae.