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Sinus venosus atrial septal defect presenting with brain abscesses in a 77-year-old immunocompetent patient

Yaser S M Alhamshari1, Chitra Punjabi1, Gregg S Pressman2

  • 1Department of Internal Medicine, Einstein Medical Center, Philadelphia, Pennsylvania, USA.

BMJ Case Reports
|October 18, 2015
PubMed

Insights

A 77-year-old patient with brain abscesses due to a congenital heart defect (sinus venosus atrial septal defect) and poor oral hygiene showed significant improvement with antibiotics and steroids. Surgical correction of the heart defect is planned.

Area of Science:

  • Neurology
  • Cardiology
  • Infectious Diseases

Background:

  • Brain abscesses can present with diverse neurological symptoms.
  • Identifying the source of infection is crucial for effective treatment.
  • Congenital heart defects can be a predisposing factor for systemic infections.

Observation:

  • A 77-year-old immunocompetent male presented with vertigo, nausea, vomiting, headache, and lethargy.
  • Brain MRI revealed ring-enhancing cerebellar lesions consistent with abscesses.
  • Transesophageal echocardiogram identified a sinus venosus atrial septal defect (ASD) with partial anomalous pulmonary venous return.
  • Poor oral hygiene and dental caries were noted as potential contributing factors.

Findings:

  • Intravenous antibiotics and steroids resulted in near-complete resolution of the cerebellar abscesses.
  • The patient's neurological symptoms significantly improved.
  • The underlying cause was identified as a sinus venosus ASD with partial anomalous pulmonary venous return.

Implications:

  • This case highlights the importance of a comprehensive diagnostic workup for brain abscesses, including cardiac evaluation.
  • Sinus venosus ASD with partial anomalous pulmonary venous return can be a potential embolic source for brain abscesses.
  • Surgical correction of the congenital heart defect is planned to prevent future complications and recurrence.

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