Cerebral cavernous malformation with associated Streptococcus pyogenes abscess in a child: a case report and literature review

Cerebral cavernous malformations (CCMs) are angiographically occult vascular lesions that present with a variety of neurological symptoms, including seizures, features of raised intracranial pressure and focal neurological deficits. In extremely rare circumstances, CCMs have presented with concomitant brain abscess formation. To date, five cases have previously been reported, the majority of which have affected patients aged 16 years or older. We present a case of a 7-year-old child with recent chickenpox infection, who presented with headache and left hemiparesis and was diagnosed with a large, deep-seated right-sided CCM with concurrent infection caused by Streptococcus pyogenes, an organism which itself is an extremely rare cause of brain abscess and may be a complication of recent chickenpox infection. The patient underwent surgical aspiration of the infected collection, completed a prolonged course of antibiotic therapy and made a good clinical recovery. Based on our review of the literature, this case represents the first reported case of Strep. pyogenes as a cause of infected CCM and only the second in a patient aged under 16 years.