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Childs Nerv Syst. 2015 Dec;31(12):2359-62. doi: 10.1007/s00381-015-2801-8. Epub 2015 Jul 3.

Pediatric brainstem abscess with hemorrhage mimicking diffuse intrinsic pontine glioma: a case report.

Author information

1
Department of Neurosurgery, Chonnam National University Medical School, Gwangju, Republic of Korea.
2
Department of Neurosurgery, Chonnam National University Medical School, Gwangju, Republic of Korea. jung-ty@chonnam.ac.kr.
3
Department of Neurosurgery, Chonnam National University Hwasun Hospital, 160, Ilsim-ri, Hwasun-eup, Hwasun-gun, Jeollanam-do, 519-809, Republic of Korea. jung-ty@chonnam.ac.kr.
4
Department of Pathology, Chonnam National University Hwasun Hospital, Gwangju, Republic of Korea.
5
Department of Radiology, Chonnam National University Hospital, Gwangju, Republic of Korea.

Abstract

PURPOSE:

We report a rare case of brainstem abscess with hemorrhage mimicking diffuse intrinsic pontine glioma (DIPG).

METHODS:

A 7-month-old baby girl presented with lethargy and poor oral feeding. She had the mild fever for 1 month. Brain computed tomography revealed the hypodense lesion in the pons. Brain magnetic resonance images (MRI) showed around 1.4-cm-sized rim-enhanced mass with perilesional edema and internal hemorrhage in the pons. The cerebral blood volume was increased in the rim-enhanced area. The provisional diagnosis was DIPG, but the mass did not show the expansile mass with encasement of the basilar artery on the ventral pons.

RESULTS:

The biopsy was done via the floor of the fourth ventricle, and the pathologic findings showed the many inflammatory cells and CD68-immunopositive macrophage which were compatible with abscess. The antibiotics with ceftriaxone and metronidazole were administrated for 11 weeks, and the follow-up MRI showed the slightly small enhanced lesion without central necrotic area. Three years later, follow-up MRI revealed the encephalomalacic change and atrophy of the pons. She had the stable neurologic deficit of left facial palsy and right hemiparesis.

CONCLUSION:

The biopsy could be necessary for pontine lesions without typical radiologic findings of DIPG.

KEYWORDS:

Abscess; Diffuse; Glioma; Pediatric; Pons

PMID:
26139548
DOI:
10.1007/s00381-015-2801-8
[Indexed for MEDLINE]

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