Diagnostic pitfall: Right frontal brain abscess presenting as presumed cervical pathology in a patient with...

Kartagener syndrome (KS), a phenotypic subset of primary ciliary dyskinesia, is characterized by defective motile cilia, impaired mucociliary clearance, chronic sinus disease, bronchiectasis, and situs abnormalities. Although respiratory manifestations predominate, central nervous system complications such as brain abscess are rare but potentially life-threatening. Because early neurological manifestations may be focal and non-specific, diagnosis can be delayed when symptoms are initially attributed to cervical or peripheral pathology.

We describe a 27-year-old male with known KS who developed a right frontal brain abscess initially misattributed to presumed cervical pathology. The patient presented with progressive left upper extremity weakness and numbness, initially managed as presumed cervical pathology. Approximately 1 month later, he was admitted after generalized tonic-clonic seizures. Initial laboratory evaluation showed leukocytosis with neutrophilia, with a white blood cell count of 14.22 × 10⁹/L and an absolute neutrophil count of 12.05 × 10⁹/L (84.6%), together with hemoglobin of 21.6 g/dL, hematocrit of 70.6%, C-reactive protein of 1.0 mg/L, erythrocyte sedimentation rate of 1 mm/h, and negative human immunodeficiency virus serology. Brain magnetic resonance imaging revealed a ring-enhancing lesion in the right frontal lobe with diffusion restriction, consistent with abscess formation. The patient initially received intravenous meropenem 2 g every 8 h. Right frontal abscess drainage was performed on May 10, 2024; intraoperative cultures showed no growth. Meropenem was continued for a documented 21-day inpatient course, and intravenous vancomycin 1 g every 12 h was added for the final 4 inpatient days. The patient achieved complete neurological recovery, and postoperative imaging demonstrated marked radiological improvement.

This case highlights a diagnostic pitfall in patients with KS presenting with focal neurological symptoms. Progressive unilateral weakness should prompt early cranial imaging, even when the initial clinical picture appears compatible with cervical pathology. Early recognition, timely drainage, and adequately documented antimicrobial management are essential to prevent morbidity.