An intra-cerebral abscess in a patient with Eisenmenger syndrome: An unusual case

We present an unusual case where a large intra-cerebral abscess with severe complications was treated successfully with medical management alone in a patient with Eisenmenger syndrome.

A 40 year old patient with Eisenmenger syndrome presented with a seven day history of headache, neck pain and intermittent vomiting and fever. The only neurological examination finding was blurred vision. MRI revealed a large left occipital lobe abscess, which subsequently ruptured into the lateral ventricle with associated ventriculitis and hydrocephalus. This complicated abscess was successfully treated with intravenous antibiotics alone, with complete resolution of the abscess and hydrocephalus on MRI at 13 months post-diagnosis.

Patients with congenital cyanotic heart conditions, like Eisenmenger syndrome, are at increased risk of developing intra-cerebral abscesses. Effectively managing large abscesses with associated intra-ventricular rupture and hydrocephalus in these patients without any form of surgical intervention, including aspiration, is extremely rare.

Patients with congenital cyanotic heart disease who develop large intra-cerebral abscesses with severe complications, which would normally warrant surgical intervention, have the potential to be successfully treated with antibiotics alone with excellent outcome.