PMC9561126_01
The dynamic imaging examination in the pre-operative period. Head computed tomography(CT) scan at admission (A), head CT on the 7th day of hospitalization (B), the patient's dental status on magnetic resonance imaging (MRI) (C), head CT on the 18th day of hospitalization (D), head MRI on the 21th day of hospitalization (E), lung CT on the 18th day of hospitalization (F).
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In addition, computed tomography(CT) of the head, chest, and abdomen was taken and revealed a possibly minor subdural effusion in the right fronto-parieto-temporal region, bilateral pulmonary inflammation, and no obvious abnormality in the abdomen ( Figure 1A ). Figure 1B ). From the above results, odontogenic intracranial infection was suspected. CT and MRI showed that the patient's dental status was basically normal ( Figure 1C ). The rechecked head CT showed the original suspicious lesion in the right frontal and fronto-parieto-temporal lobe had become abscess-like, with the right lateral ventricle being pressed and the midline structure was shifted to the left ( Figure 1D ). So, the head magnetic resonance imaging (MRI) was taken and confirmed the formation of multiple brain abscesses ( Figure 1E ). CT also revealed the formation of multiple pulmonary abscesses ( Figure 1F ). Combined with the results of mNGS, odontogenic pulmonary and brain abscesses were further confirmed.
The follow-up head magnetic resonance imaging (MRI) image of post-operation. Head MRI on the 5th day after operation (A), Head MRI on the 14th day after operation (B), Head MRI on the 23rd day after operation (C), Head MRI on the 30th day after operation (D), Head MRI at the time of discharge (E, F).
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The MRI on the 5th-day post-operation showed the brain abscess was significantly smaller ( Figure 2A ), but worsened in the MRI on the 14th day post-operation ( Figure 2B ). Unlike the temperature, the follow-up head MRI showed no significant changes of the brain abscesses ( Figures 2C-F ), thus his anti-infective treatment lasted for 92 days' hospitalization.
Body temperature and anti-infective treatment during hospitalization, meropenem 2.0 g q8h (day 1-55), linezolid 600mg q12h (day 2-5, day 36-92), tigecyclin 100mg q12h (day 10-15), ornidazole (day 13-54), ceftriaxone(day 56-92).
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Considering the overall stability of the patient's condition, he was transferred to the infection ward to continue the treatment, meropenem, ceftriaxone, ornidazole, and linezolid was given intravenously successively, and his temperature returned to normal after 9 weeks of anti-infective treatment ( Figure 3 ).
Change in C-reactive protein (CRP) and procalcitonin(PCT) during hospitalization.
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In accordance with temperature, C-reactive protein (CRP) and procalcitonin (PCT) during hospitalization dropped continuously ( Figure 4 ).