Brain Abscess as the Initial Manifestation of Hereditary Hemorrhagic Telangiectasia in a Child

Brain abscess secondary to pulmonary arteriovenous malformation is rare in children and may be the first manifestation of hereditary hemorrhagic telangiectasia (HHT).

We retrospectively reviewed the clinical presentation, laboratory findings, imaging examinations, and diagnostic process of a child with brain abscess associated with pulmonary arteriovenous malformation and HHT.

A 12-year-old boy presented with fever, headache, and limb weakness. Brain abscess was diagnosed, and antimicrobial therapy was initiated. Laboratory testing revealed fungal infection and erythrocytosis. Further evaluation identified a pulmonary arteriovenous malformation. Although the family history was initially unremarkable, physical examination revealed facial telangiectasia, recurrent epistaxis, and digital clubbing in his father, fulfilling the Curaçao criteria for HHT.

Right-to-left shunt should be considered in children with brain abscess of unclear origin. Early recognition of underlying HHT is critical for timely diagnosis and management.