Anthrax meningoencephalitis complicated with brain abscess - A case report.

Bacillus anthracis is a sporulating Gram positive rod whose main route of entry being cutaneous. Anthrax meningitis is usually fulminant and fatal. We present here a case of anthrax meningoencephalitis complicated with brain abscess successfully treated. The patient was a shepherd, with onset of the disease seven days ago with fever, chills, occipital headache, and vertigo, followed by right hemiplegia, motor aphasia, agitation and coma. He had cutaneous lesions with black eschar on the limbs and this was a clue (along with his occupation), for diagnosis suspicion. The PCR for Bacillus anthracis DNA was positive in both CSF and cutaneous lesions. The CSF was compatible with bacterial meningitis, without being haemorrhagic. The MRI showed meningeal enhancement and multiple intraparenchymal heterogeneous lesions with an important haemorrhagic component in the left parietal lobe, surrounded by vasogenic edema with maintenance, 22 days later, of the left parietal lobe lesion, having a ring contrast enhancement and a central diffusion restriction, compatible with an abscess. From admission, he was intensively treated with combined large-spectrum antibiotics and this could be the most valuable factor for his good outcome.