A Case Report of Crohn's Disease Complicating with Brain Abscesses and Splenic Abscesses caused by Infection of Central Venous Catheter and Subcutaneal Port

Ken-ichi Takahashi, Yuji Funayama, Kouhei Fukushima, Chikashi Shibata, Akihiko Hashimoto, Munenori Nagao, Sho Haneda, Kazuhiro Watanabe, Katsuyoshi Kudo and Iwao Sasaki

Department of Surgery, Division of GI and Colorectal Surgery (Research Unit of Biomedical Regulation and Oncology), Tohoku University Graduate School of Medicine

A 40-year-old man with Crohn's ileocolitis and undergoing home parenteral nutrition (HPN) using an implanted port due to malnutrition and intractable enterocutaneus fistula was referred for hospitalization due to loss of consciousness after 1 week of a high-grade fever. Cerebrospinal fluid examination showed bacterial meningitis and positive blood culture of gram-positive cocci necessitating immediate removal of the implanted port for suspected catheter sepsis. CT and magnetic resonance imaging showed brain and splenic abscesses. Because of a severe hemorrhagic tendency, surgical intervention was not selected. After the catheter was removed and intravenous antibiotics administered, his general condition and brain and splenic abscesses improved with conservative therapy alone. Cultures of blood, spinal fluid, and the catheter tip were all positive for Staphylococcus aureus. Both brain and splenic abscess are a rare complications of catheter-related sepsis, but it is important that appropriate instructions on HPN complications and measures be provided to prevent these severe complications.

Key words
brain abscess, splenic abscess, home parenteral nutrition

Reprint requests
Ken-ichi Takahashi Department of Surgery, Division of GI and Colorectal Surgery (Research Unit of Biomedical Regulation and Oncology), Tohoku University Graduate School of Medicine
1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574 JAPAN

Accepted
March 30, 2005

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