Home›Allergy & Immunology› MRSE Brain Abscess After Stent-Assisted Coiling for Ruptured Aneurysm Treated With Drainage
MRSE Brain Abscess After Stent-Assisted Coiling for Ruptured Aneurysm Treated With DrainageTreatment Strategy for Rare Brain Abscess After Aneurysm Surgery
Frontiers in MedicinePublished October 27, 2026DOI ↗Editorial oversight: Dr. Amelia Tan, PhD · Internal Medicine & Chronic Disease
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Key Takeaway
Consider brain abscess in the differential after endovascular aneurysm treatment, though this is a single case.
This is a case report with an accompanying literature review, not a comparative study. It describes a 49-year-old man with subarachnoid hemorrhage from a ruptured anterior communicating artery aneurysm who underwent stent-assisted coil embolization and later developed a brain abscess. The abscess measured 42 mm x 27 mm, and methicillin-resistant Staphylococcus epidermidis (MRSE), ST2 subtype, was identified. Management combined meropenem, metronidazole, and vancomycin with robot-assisted stereotactic abscess drainage.
The authors also report laboratory and imaging findings, including increased IL-1beta, IL-6, TNF-alpha, and IL-10 and decreased CD3+, CD4+, CD8+, CD19+, CD20+, and NK cells. Follow-up extended to 6 months. No comparator group, primary outcome definition, effect sizes, or statistical testing are reported, so no quantitative inference about treatment effect is possible.
The authors frame the case as a rare complication of endovascular therapy and as a rationale for optimizing treatment of MRSE-associated brain abscess. They acknowledge the small sample size inherent to a case report as a limitation. Funding and conflicts of interest are not reported.
Practice relevance is limited to awareness: clinicians caring for patients after endovascular aneurysm treatment may consider that abscess is a possible, albeit rare, complication, and that pathogen-directed therapy plus drainage was the approach used here. The report does not establish incidence, risk factors, or comparative effectiveness of any component of care. Certainty is low.
How this fits prior evidence
This case report does not test a treatment strategy, so it neither confirms nor contrasts with prior coverage of continuous vancomycin infusion for Gram-positive infections, where the focus was nephrotoxicity risk and target attainment. It extends the publication's pathogen-specific coverage into a rare central nervous system infection caused by MRSE, a setting distinct from the pooled VRE prevalence estimate of 18.4% in hematologic malignancy patients and from the pediatric empyema pathogen data. Vancomycin appears only as part of a multi-drug regimen, with no pharmacokinetic or outcome comparison reported.
A single case report describes the experience of a 49-year-old man who suffered a subarachnoid hemorrhage caused by a ruptured artery. Following his procedure, he developed a brain abscess measuring 42 mm by 27 mm. The infection was identified as a specific type of bacteria called methicillin-resistant Staphylococcus epidermidis.
The patient received a combination of treatments. This included stent-assisted coil embolization, antibiotic therapy with meropenem, metronidazole, and vancomycin, followed by robot-assisted drainage of the abscess. Doctors also observed changes in immune markers and a decrease in certain immune cells during the process.
Because this is a single case report, the findings are not enough to make broad claims about how this condition behaves in others. However, it provides a specific example of how doctors can manage a rare complication after a brain procedure. Patients with similar concerns should discuss their specific treatment plans with their medical team.
What this means for you:
This single case report highlights a specific treatment path for a rare infection following brain surgery.
Common questions
What caused the infection in this patient?
The patient developed a brain abscess caused by methicillin-resistant Staphylococcus epidermidis (MRSE), specifically the ST2 subtype. This occurred following a subarachnoid hemorrhage from a ruptured artery. The abscess was measured at 42 mm by 27 mm.
What treatments were used to manage the abscess?
The patient received a combination of treatments including stent-assisted coil embolization, antibiotic therapy with meropenem, metronidazole, and vancomycin. They also underwent robot-assisted stereotactic abscess drainage to treat the infection.
Is this a common complication after brain surgery?
This is considered a rare complication. Because this information comes from a single case report, it is not enough to determine how common the issue is. You should speak with a doctor regarding specific risks for any procedure.
BackgroundEndovascular treatment(EVT) is a key therapeutic approach for ruptured intracranial Aneurysms; however, postoperative brain abscesses are extremely rare, and their pathogenesis and optimal treatment strategies remain unclear. This article reports a case of a Staphylococcus epidermidis-associated brain abscess that developed following stent-assisted coil embolization for subarachnoid hemorrhage caused by a ruptured anterior communicating artery aneurysm and discusses the underlying immune and inflammatory mechanisms as well as treatment strategies.Case presentationA 49-year-old man underwent stent-assisted coil embolization for subarachnoid Hemorrhage(SAH) from a ruptured anterior communicating artery aneurysm. Recovered well from operation and discharged. He, however, presented on the 34th postoperative day with a high-grade fever, headache, nausea, and vomiting. Brain imaging showed a brain abscess in the left frontal lobe, approximately 42 mm × 27 mm. However, there were no clear signs of severe neurological deterioration or a critical phase of cerebral herniation. Laboratory tests revealed high white blood cell and neutrophil counts, low lymphocyte counts, and variable reductions in CD3+, CD4+, and CD8+ T cells, CD19+ and CD20+ B cells, and Natural Killer cells(NK cells). Meanwhile, IL-1β, IL-6, TNF- α, and IL-10 levels increased, indicating deep immunological and inflammatory changes during infection. Inflammatory and immune markers improved slightly after antimicrobial therapy, but clinical symptoms persisted, and robot-assisted stereotactic abscess drainage was performed. A culture of pus grew methicillin-resistant Staphylococcus epidermidis (MRSE). Whole-genome sequencing confirmed the species and ST2 subtype and genetic features associated with β-lactam resistance. Initially, based on the consultation findings, meropenem and metronidazole were empirically administered as broad-spectrum antibiotics; after MRSE was confirmed, treatment was switched to vancomycin, and the patient’s clinical symptoms and laboratory parameters gradually improved. Postoperative imaging showed no recurrence of abscess, and the patient was in satisfactory general condition and no aftereffects whatsoever at six months’ follow-up.ConclusionWe present a case report of an isolated brain abscess due to Staphylococcus epidermidis that developed after EVT of a ruptured intracranial aneurysm, which is a novel and clinically rare case. It also provides new clinical evidence for understanding this type of rare complication and optimizing treatment strategies.
