PMC9836056_01
a and b, Diffusion sequence (a) and T2 (b) weighted sequences with arrows pointing to pus within in the abscesses. (c), T1 post-contrast sequence with arrowheads pointing to enhancement of the abscess walls. (d) and (e), Diffusion sequence (d) and T2 (e) sequences with arrows pointing to pus within the ventricles. (f), T1 post-contrast sequence with arrowheads pointing to enhancement of the ependymal surfaces of the ventricles.
acmi-4-430-g001.jpg
PMC9836056_01_acmi-4-430-g001.jpg
F1
He had development of ventriculitis with purulence in the lateral ventricles, increased cystic degeneration and midline shift, progressive encephalomalacia, and new areas of restricted diffusion representing evolving areas of infarction (Fig. 1).
Trend of white blood cell count in the CSF (K microl-1) with important events. 1) Meropenem started; 2) Transition to continuous meropenem; 3) Identification of 

P. thiaminolyticus

; 4) Sensitivities obtained.
acmi-4-430-g002.jpg
PMC9836056_01_acmi-4-430-g002.jpg
F2
He had demonstrated improvement in neurological examination and WBC in his CSF since transition to continuous meropenem, so the decision was made to continue this therapy and not add or broaden coverage (Fig. 2).