Abstract
A brain abscess which developed in a hemodialysis patient was successfully treated without surgical intervention. A 68-year-old man with a two-year history of hemodialysis was admitted to our hospital because of high fever and headache. On admission, nuchal rigidity and double vision were noted.
Leucocytosis was absent in peripheral blood and CRP was negative. Cerebrospinal fluid demonstrated a significant increase in polymorphonuclear cells and a low glucose level suggesting bacterial meningitis. An antibiotic, cefotaxime (CTX), was thus administered. Intially CTX treatment resulted in temporary improvement, but several days later his clinical condition and CSF findings worsened. CT scans of the head revealed a low absorptive region of 3cm in diamiter with marginal enhancement in the left posterior lobe, suggesting a diagnosis of brain abscess. Drainage of the abscess was contemplated, he was thought to be a high risk candidate because of his serious complications. We decided to treat him conservatively by changing the antibiotic to imipenem. Treatment for 6 weeks resulted in resolution of the brain abscess. To date, 12 months after discontinuation of the antibiotics, there is no evidence of recurrence of the brain abscess. We feel that in treating brain abscess in a hemodialysis patient, non operative management should be initiated first with weekly follow up by CT scanning, and if there is no improvement in a few weeks, surgical intervention should be performed.
