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A cerebral abscess at first internist glance.

Rita Ribeiro1, Catarina Patrício1, Margarida Moura Valejo Coelho2

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A cerebral abscess diagnosis was reconsidered due to atypical imaging findings. Escherichia coli endocarditis, linked to a prior urinary tract infection, was identified as the cause of neurological symptoms.

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Area of Science:

  • Neurology
  • Infectious Diseases
  • Cardiology

Background:

  • A 73-year-old male presented with neurological deficits and fever, initially suspected as a cerebral abscess.
  • Imaging revealed a right temporal lobe lesion with extensive surrounding edema, suggesting a vascular territory involvement.

Observation:

  • The patient exhibited left-sided hemiplegia and a confusional state.
  • Echocardiography identified mitral endocarditis.
  • Blood and abscess cultures isolated Escherichia coli, which was also previously identified in a urine specimen after catheterization for urinary retention.

Findings:

  • The clinical presentation and microbiological findings pointed away from a primary cerebral abscess.
  • Escherichia coli endocarditis, originating from a urinary tract infection, was determined to be the cause of the neurological manifestations.

Implications:

  • This case highlights the importance of considering infective endocarditis as a cause of focal neurological deficits, even with initial suspicion of cerebral abscess.
  • A thorough patient history, including recent procedures and prior infections, is crucial for accurate diagnosis and management of complex neurological presentations.