Deep brain stimulation procedure complicated by intracerebral infection of DBS lead due to outbreak of COVID-19 pandemic.

Deep brain stimulation (DBS) is a life-long treatment. Patients require scheduled follow-up visits in order to spot possible hardware-related infections [1]. The constant care of patients with DBS systems due to the COVID-19 pandemic has been almost completely stopped or been rescheduled to telemedicine, especially in the first months after the pandemic hit the world [2–5]. The fear and anxiety of infection prevented many patients with newly implanted DBS systems from reporting for skin stitches removal and subsequent scheduled follow-up visits in DBS treating experienced centres. Herein, we report a case of early DBS hardware infection with intracerebral spread during the first month of the COVID-19 pandemic. Our aim was to present the difficulties faced by a patient with a newly implanted DBS system just before the COVID-19 pandemic with a possible life-threatening infectious complication. A 64-year-old right-handed male with a 13-year history of PD was admitted to the neurosurgical department for a scheduled second-side staged implantation of a DBS system. The first right-sided STN (subthalamic nucleus) DBS procedure had been performed in February 2019 and resulted in a significant reduction of parkinsonian symptoms on the left side. A second stereotactic procedure was proposed, and the patient agreed and signed written informed consent before the surgery. The left-sided STN DBS procedure was scheduled for the beginning of March 2020. The STN DBS procedure was uneventful, with excellent control of parkinsonian right-sided symptoms after turning on the stimulation. In mid-March 2020, the COVID-19 pandemic began. Nearly all outpatient visits completely stopped. The skin stitches were removed later than the scheduled time limit at the patient’s home. Usually, stitches after the DBS procedure are removed within 10 days after surgery at our outpatient clinic. Probably incomplete skin stitches removal resulted in superficial wound infection. The patient did not attend at the standard postoperative visit at our outpatient clinic one month after surgery. The patient did present to our clinic after two months, with signs of infection around the connector in the left parietal region. Wound debridement was carried out with relocation of the connector. A bacterial culture revealed infection caused by Proteus mirabilis. An oral antibiotic was prescribed. Despite the antibiotic treatment, the patient was admitted to the emergency unit with visible purulent discharge from the cutaneous incision in the left parietal area (Fig. 1A). The patient was reoperated and, due to the presence of pus limited only to the connector site, it was decided not to remove the intracranial DBS electrode. The patient was treated with intravenous and subsequently with oral antibiotics for six weeks. The left-sided DBS system infection appeared to be challenged successfully. Unfortunately, at the end of October 2020, the patient experienced chills, a headache, and a fever. The skin area around the burr hole turned red and warm. There was a slight erosion with visible purulent drainage (Fig. 1B). An emergency head CT scan revealed prominent oedema suggesting