First report of intracranial epidermoid cyst infection and brain abscess caused by Salmonella Paratyphi A

We report the first case of brain abscess caused by Salmonella Paratyphi A in a young immunocompetent boy with an intracranial epidermoid cyst. A 10-year-old boy presented with gradual onset of headache, progressively increasing over one month duration. The patient was diagnosed with a benign intracranial epidermoid cyst involving the left anterior cranial fossa insinuating to left medial frontal lobe due the initial presentation, and repeat magnetic resonance Imaging taken after two weeks during to worsening of headache revealed pyogenic infection of the epidermoid cyst. The drained pus showed plenty of polymorphonuclear cells with thin Gram-negative bacilli on Gram staining and culture revealed the growth of S. Paratyphi A, which was confirmed by VITEK 2 compact system and serotyping. The isolate was susceptible to Ampicillin, Cotrimoxazole, Ciprofloxacin, Ceftriaxone and Tetracycline. The patient was successfully managed initially with empirical intravenous Meropenem for two weeks and then deescalated to oral Cefixime and Ciprofloxacin. There were no focal neurological deficits while the patient was discharged with advice on antibiotic continuation for two weeks.