In the setting of HIV, cerebral lesions are usually secondary to lymphoma and opportunistic infections; however, in patients with CD4 counts above 200 cells/uL, other pathologies such as pyogenic brain abscess could gain importance. The microbiology of pyogenic brain abscess has Staphylococcus
as the leading etiologic pathogens in immunocompetent individuals. Peptostreptococcus
is also recognized as a common cause of brain abscess in this patient population. In HIV-infected individuals, there have been sporadic reports of Peptostreptococcus
infections but none of brain abscess. We describe the case of a 43-years-old HIV-infected patient with a CD4 count of 350 cells/uL that developed a Peptostreptococcus
brain abscess presumably from hematogenous spread of an odontogenic source. Treatment with stereotactic needle aspiration in two opportunities and four weeks of intravenous antibiotics led to a complete resolution of this infection. This case highlights the importance of a multidisciplinary approach for an effective treatment of pyogenic brain abscess in HIV-1 patients.
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