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Background: Clostridium perfringens (C. perfringens) is the most frequently involved pathogen in gas-containing brain abscesses, most of them in the setting of penetrating traumatic brain injury. Postcraniotomy brain abscesses caused by C. perfringens are quite unusual, with very few cases reported previously in the literature. Case Description: A 17-year old male was admitted to the emergency department with signs of infection in surgical wound. He had been operated on for a recurrent craniopharyngioma two months ago. CT scan showed a gas-containing fluid collection under cranioplasty and leptomeningeal and parenchymatous enhancement. He underwent urgent surgical intervention and cultures showed C. perfringens and Proteus mirabilis growth. Broad spectrum antibiotics were administered and after 6 weeks, he was discharged home in his previous functional state. Conclusions: Clostridial brain abscess should be in the differential diagnosis of gas-containing infections after craniotomy. Surgical debridement and antibiotics are the basis of treatment, having a much better prognosis than clostridial infections outside the nervous system.

Postcraniotomy Brain Abscess and Empyema by Clostridium Perfringens. An Unusual Neurosurgical Complication