Propionibacterium acnes Infection with Intracerebral Abscess in Deep Brain Stimulation

Propionibacterium acnes (P. acnes) infection in Deep Brain Stimulation (DBS) patients has distinct characteristics that distinguish it from the most commonly associated bacteria in postoperative wound infections, Staphylococcus aureus (S. aureus). Whereas S. aureus is typically cultured from patients presenting with early fever and elevated inflammatory markers, P. acnes infections in DBS have been found to present with later clinical onset and unremarkable inflammatory markers. The purpose of this report is to highlight the unique characteristics of P. acnes infections in DBS patients. We review the literature in conjunction with a series of three P. acnes DBS infections at our institution. All three cases resulted in the development of abscess surrounding the lead, requiring complete hardware removal. All explanted lead cultures yielded P. acnes. The unifying feature amongst the cases was the presentation of neurological symptoms in the absence of fever or elevated inflammatory markers. Given the context of late complications and need for revision surgery, P. acnes infections must be taken into consideration in DBS patients in order to avoid additional harm.