Patient went on to have surgery.
Sections of brain tissue show a central well circumscribed cavity containing inflammatory necrotic material with abundant neutrophils and foamy macrophages present. The adjacent brain parenchyma contains prominent capillary sized blood vessels and reactive gliosis. No parasites are seen. There is no evidence of malignancy. Special stains (PAS, Grocott, Gram and ZN) are negative for fungal and bacterial micro-organisms.
DIRECT EXAMINATION: Calcofluor White Stain: No fungal elements detected
GRAM STAIN: Leucocytes +, Gram negative bacilli +++, Gram positive cocci ++
- Streptococcus anginosus group (milleri group) ++
- Prevotella oris ++
SENSITIVITIES 1, Ceftriaxone S, Penicillin S
FINAL DIAGNOSIS: cerebral abscess