• David H Jho, Konstantinos Spiliopoulos, Thor D Stein, and Ziv Williams.
• Neurosurgery Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
• World Neurosurg. 2011 Jan 1; 75 (1): 126-31; discussion 50-3.

BackgroundThe coexistence of a primary brain tumor such as high-grade glioma and superimposed abscess is a rare entity and can present a diagnostic and therapeutic challenge. The concomitant abscess may not be recognized until surgery, and the overall course of treatment may require adjustment in the presence of a coinciding infection. In the present report we evaluate the diagnosis and treatment of a glioblastoma multiforme with an intratumoral abscess.MethodsA patient was diagnosed with a glioblastoma multiforme with a concomitantly superimposed multimicrobial abscess containing coagulase-negative Staphylococcus, Acinetobacter iwofii, and Propionibacterium species. The suspected infectious source was a dental abscess with presumed secondary seeding. The patient underwent a left anterior temporal lobectomy with debulking of the lesion. Although the adjuvant therapy schedule was adjusted to accommodate the course of antibiotics, the existence of a concurrent abscess did not preclude adjuvant radiation and chemotherapy.ResultsThe patient responded well to antibiotic treatment with no evidence of recurrent infection. He underwent a second operation for additional debulking of the lesion approximately half a year after his initial surgery. The patient died 2 years after the initial diagnosis.ConclusionsThere are insufficient guidelines on the treatment of a primary brain tumor with intratumoral abscess. In this report we present our therapeutic decisions in this rare case.Copyright © 2011 Elsevier Inc. All rights reserved.

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