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Management challenges in a schizophrenic patient with multiple brain abscesses: A case report

Published online by Cambridge University Press:  13 August 2021

M. Huete Naval*
Affiliation:
Psychiatry And Mental Health, Hospital Clínico San Carlos, Madrid, Spain
P. Albarracin
Affiliation:
Psychiatry And Mental Health, Hospital Clínico San Carlos, Madrid, Spain
R. Galeron
Affiliation:
Psychiatry And Mental Health, Hospital Clínico San Carlos, Madrid, Spain
E. Herrero
Affiliation:
Psychiatry And Mental Health, Hospital Clinico San Carlos, Madrid, Spain
L. Gallego Deike
Affiliation:
Psychiatry And Mental Health, Hospital Clinico San Carlos, Madrid, Spain
*
*Corresponding author.

Abstract

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Introduction

Cerebral abscesses are rare, occurring in approximately 0.3–1 per 100 000 patients. Mortality rate still remains as high as 22%. Very few cases of acute psychotic episodes associated with brain abscess have been reported.

Objectives

To present a case report of a patient with schizofrenia associated with multiple brain abscesses, focusing on clinical features and managing challenges.

Methods

Presentation of a clinical case supported by a non-systematic review of literature containing the key-words “brain abscess”, “psychosis” and “schizophrenia”

Results

This is a case report of a male 44-year-old patient with a known history of schizophrenia since the age of 18 and with multiple brain abscesses diagnosed 2 month ago. He was admitted to our inpatient service after discontinuation of her medication resulting in an acute psychotic episode. Antibiotic therapy with rifampicine, metronidazole, trimethoprim and sulfamethoxazole was started. Also, administration of clozapine was initiated (up to 400mg/day) with partial improvement, so aripiprazole was added (up to 45 mg/day), with insufficient response. We suspected of a drug interaction between rifampicine (known potent broad inducer of drug-metabolizing enzymes) and antipsychotic medication, so we decided to change aripiprazole to amisulpride 1200 mg/day, which CYP-catalyzed metabolism appears to be minor. A significant improvement in positive symptoms and mood was observed. The patient has since had no delusions or hallucinations and is living independently at home.

Conclusions

This clinical case highlights the possible association between brain abscesses and relapses in schizophrenia. It is of utmost importance to be aware for possible drug interactions between antibiotic therapy and antipsychotic medication.

Disclosure

No significant relationships.

Type
Abstract
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of the European Psychiatric Association
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