An Unlikely Telemedicine Diagnosis: A Case Report of Rhizobium Radiobacter Brain Abscess

Abstract

Introduction: Rhizobium radiobacter is a gram negative bacillus commonly found in soil The frequency ofreported infections in the pediatric population is rare and typically affects immunocompromised patients Thiscase highlights the incidence of a Rhizobium Radiobacter infection, prompted by a telemedicine consultation,in a healthy pediatric patient with no known risk factors Case Description: A 12-year-old male with a history ofchronic sinusitis and renal agenesis presented to the emergency department after a new-onset generalizedseizure The patient complained of having intermittent fevers for 5 days and left ear pain as well as left sidedperiorbital swelling He was febrile with elevated leukocytosis and inflammatory markers, and found to haveextensive left-sided sinusitis with no focal neurological deficits He was subsequently discharged withantibiotics and instructions to follow-up in one month with a pediatric neurologist Three days after the initialpresentation, he returned to the emergency department with persistent fever and headache He wasdetermined to have a sinus headache and instructed to complete the antibiotic course The following day, he was evaluated by pediatric neurology via telemedicine Secondary to the new onset seizures and changes inneurological status, he was referred for emergent inpatient admission Just prior to arrival, the patient had a20-minute nonverbal episode, prompting rapid video EEG placement which was suggestive of seizure activity The patient received a loading dose of levetiracetam and began maintenance dosing Despite AEDs, thepatient continued to have multiple subclinical seizures in the frontal lobe MRI brain was indicative ofmeningoencephalitis involving the left hemisphere, left frontal lobe cerebritis,and a multilocular extra-axialabscess At this time intravenous antibiotics were begun at meningitic dosing The patient was taken foremergent craniotomy for abscess evacuation, and cultures were found to be positive for RhizobiumRadiobacter Discussion: In the setting of fever and new-onset seizure in an otherwise healthy patient,meningitis should be high on the differential Infectious etiology cannot be excluded and necessitates furtherinvestigation including lumbar puncture with cerebrospinal fluid cultures The delay in ascertaining a spinaltap, alongside the late-onset of IV antibiotic use, propagated the formation of a bacterial abscess Conclusion:During the COVID-19 pandemic, the availability of telemedicine proved to be a lifesaving service The clinicalacumen of the neurologist prompted admission to the hospital for further evaluation and the eventualdiagnosis of a bacterial brain abscess A telehealth consultation with the patient in his home setting allowedfor the thorough history-taking required to develop the connection between the neurological changes andrecent sinusitis This case exemplifies the functionality of pediatric telemedicine and serves to highlight aunique pathogen in this patient population