Fusobacterium brain abscess as a complication of sinusitis in an immunocompetent adolescent: A case report

Figure 2 Clinical timeline of presentation, management, and recovery in a child with Fusobacterium nucleatum brain abscess secondary to sinusitis. Day -5 to 0: Fever, headache, and altered sensorium led to magnetic resonance imaging showing bilateral frontal and left temporal subdural abscess with sinusitis. Day 0-2: Empirical ceftriaxone, vancomycin, and metronidazole were initiated; burr-hole drainage performed. Day 4-7: Gradual neurological improvement, persistent fever. Day 8-10: Next-generation sequencing confirmed Fusobacterium nucleatum; vancomycin stopped, ceftriaxone and metronidazole continued. Day 12-14: Repeat computed tomography showed paradoxical effusion enlargement; repeat drainage performed. Day 15-28: C-reactive protein decreased (136 mg/L→13 mg/L); afebrile, seizure-free. Follow-up: Completed 4-week IV antibiotics; discharged neurologically intact with normal speech and gait. MRI: Magnetic resonance imaging; CT: Computed tomography; IV: Intravenous; NGS: Next-generation sequencing; CRP: C-reactive protein; BI: Bilateral.