A 64-year-old man was admitted with new-onset seizures. His examination was normal with no neurological deficits. Computed tomography of the brain showed a hypodense left parietal lobe lesion, but he insisted on early discharge. He was readmitted 12 days later with recurrent seizures. Brain imaging showed significant increase in size of brain mass. Emergent surgery revealed an abscess, which subsequently grew methicillin-resistant Staphylococcus aureus (MRSA). The patient was treated postoperatively with intravenous vancomycin for 8 weeks.
The patient had no risk factors for hospital-acquired infection but recalled having a furuncle 6 weeks before presentation. The diagnosis of community-acquired MRSA abscess was made epidemiologically and on antibiotic sensitivity profile.
Community-acquired MRSA infections are becoming increasingly prevalent with ever-increasing spectrum of invasive presentations. Only 4 cases of Community-acquired MRSA brain abscess have been previously reported, of which 3 had fatal outcomes. In contrast, our patient had complete recovery. A reappraisal of current treatment guidelines for community-acquired brain abscesses, which do not include vancomycin for empiric coverage of MRSA, should be considered.