What question did this study set out to answer?

To explore the atypical presentation of a brain abscess due to E. lenta and B. wadsworthia coinfection in an elderly patient.

March 13, 2026Cureus1 citationsOpen Access

Atypical Presentation of an Odontogenic Brain Abscess Due to Eggerthella lenta and Bilophila wadsworthia Coinfection

MCMan Fung ChengPrincess Margaret Hospital EDErnest DodooPrincess Margaret Hospital

Key Points

To explore the atypical presentation of a brain abscess due to E. lenta and B. wadsworthia coinfection in an elderly patient.
Case report of an 81-year-old man
Surgical excision via right frontal craniotomy
Antibiotic treatment with ceftriaxone and metronidazole followed by oral cephalexin
Successful surgical excision of the brain abscess
Antibiotic therapy led to a favorable clinical outcome
Coinfection associated with periodontitis contributed to pathogenesis

Abstract

Odontogenic brain abscesses are uncommon. Eggerthella lenta and Bilophila wadsworthia are anaerobes that are normal components of the human intestinal microbiota. Both can also be found in the oral cavity. We report the case of an 81-year-old man with a brain abscess caused by coinfection of E. lenta and B. wadsworthia associated with periodontitis. The patient underwent a right frontal craniotomy with excision of the abscess. Ceftriaxone and metronidazole were then started, along with levetiracetam. Ceftriaxone and metronidazole were maintained for four weeks, and the antibiotic treatment was switched to oral cephalexin and metronidazole for an additional two weeks. Immune senescence and bacterial translocation play an important role in pathogenesis. Early detection, surgical excision of the abscess, and antibiotic therapy resulted in a favorable clinical outcome.

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