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Picchi E, Pucci N, Amatruda A, Fu F, Leomanni P, Ferrazzoli V, Di Giuliano F, Garaci F. Cerebritis, optic ischemia, and cavernous sinus thrombosis arising from sinonasal mucormycosis. Radiol Case Rep 2024; 19:3693-3700. [PMID: 38983289 PMCID: PMC11228663 DOI: 10.1016/j.radcr.2024.05.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Revised: 05/16/2024] [Accepted: 05/19/2024] [Indexed: 07/11/2024] Open
Abstract
Brain and ocular infections can be the worst and fatal consequences of sinonasal infections in immunomodulated or immunocompromised patients. We report a case of a 35-year-old female who received an allogenic hematopoietic stem cell transplantation for acute myeloid leukemia, suffering from maxillo-spheno-ethmoidal rhinosinusitis which was complicated by cavernous sinus thrombosis, orbital cellulitis, optic ischemia and cerebritis.
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Affiliation(s)
- Eliseo Picchi
- Diagnostic Imaging Unit, University Hospital of Rome "Tor Vergata", Viale Oxford 81 00133, Rome, Italy
- Department of Systems Medicine, University of Rome "Tor Vergata", Via Montpellier 1 00133 Rome, Italy
| | - Noemi Pucci
- Diagnostic Imaging Unit, University Hospital of Rome "Tor Vergata", Viale Oxford 81 00133, Rome, Italy
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Via Montpellier 1 00133 Rome, Italy
| | - Alessia Amatruda
- Diagnostic Imaging Unit, University Hospital of Rome "Tor Vergata", Viale Oxford 81 00133, Rome, Italy
| | - Francesca Fu
- Diagnostic Imaging Unit, University Hospital of Rome "Tor Vergata", Viale Oxford 81 00133, Rome, Italy
| | - Paola Leomanni
- Diagnostic Imaging Unit, University Hospital of Rome "Tor Vergata", Viale Oxford 81 00133, Rome, Italy
| | - Valentina Ferrazzoli
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Via Montpellier 1 00133 Rome, Italy
- Neuroradiology Unit, Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Viale Oxford 81 00133, Rome, Italy
| | - Francesca Di Giuliano
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Via Montpellier 1 00133 Rome, Italy
- Neuroradiology Unit, Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Viale Oxford 81 00133, Rome, Italy
| | - Francesco Garaci
- Diagnostic Imaging Unit, University Hospital of Rome "Tor Vergata", Viale Oxford 81 00133, Rome, Italy
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Via Montpellier 1 00133 Rome, Italy
- Neuroradiology Unit, Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Viale Oxford 81 00133, Rome, Italy
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Prasad SN, Sharma S, Singh V, Phadke RV. Endovascular management of pulmonary arteriovenous malformations presenting as multiple brain abscesses. BMJ Case Rep 2022; 15:e251593. [PMID: 36414347 PMCID: PMC9685250 DOI: 10.1136/bcr-2022-251593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Pulmonary arteriovenous malformations (PAVMs) are rare vascular lesions characterised by abnormal connections between the pulmonary artery and vein bypassing the pulmonary capillary bed and causing right-to-left shunt. Paradoxical embolism is known to occur in these cases, leading to inoculation of septic focus in the systemic circulation. We report a case of multiple PAVMs who presented clinically with seizures and altered sensorium. On radiological work-up, multiple brain abscesses and large PAVMs were evident. The patient was successfully treated by endovascular embolisation of the PAVMs using a vascular plug and multiple coils. The patient showed complete clinical recovery and resolution of brain abscesses on follow-up.
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Affiliation(s)
- Surya Nandan Prasad
- Radiodiagnosis, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Srishti Sharma
- Radiodiagnosis, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Vivek Singh
- Radiodiagnosis, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Rajendra Vishnu Phadke
- Radiodiagnosis & Interventional Radiology, Apollomedics Super Speciality Hospitals, Lucknow, Uttar Pradesh, India
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Mishra B, Agarwal A, Gupta A, Garg A, Vishnu VY, Rajan R, Singh MB, Bhatia R, P Srivastava MV. Intracranial Abscess Unmasking Pulmonary AVF Due to Clandestine Hepatopulmonary Syndrome. Neurol India 2022; 70:2223-2224. [PMID: 36352652 DOI: 10.4103/0028-3886.359185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Biswamohan Mishra
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Ayush Agarwal
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Anu Gupta
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Ajay Garg
- Department of Neuroradiology, All India Institute of Medical Sciences, New Delhi, India
| | - Venugopalan Y Vishnu
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Roopa Rajan
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Mamta B Singh
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Rohit Bhatia
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - M V P Srivastava
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
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Spier AB, David D, Al Zoubi M, Taylor M, Evans CE. Silent persistent left superior vena cava right-to-left shunt as a unique cause of recurrent brain abscesses. Open Forum Infect Dis 2022; 9:ofac160. [PMID: 35493120 PMCID: PMC9045951 DOI: 10.1093/ofid/ofac160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 03/22/2022] [Indexed: 11/15/2022] Open
Abstract
Abstract
We present a novel case of recurrent brain abscesses found to be the result of a silent congenital right-to-left extra-cardiac shunt, a persistent left superior vena cava (PLSVC) draining into the left atrium. The patient’s brain abscess was evacuated surgically, treated with antibiotics, and his shunt was subsequently repaired. The case suggests that attention should be paid to evaluation for shunt physiology allowing for bypass of the pulmonary circulation in those with recurrent brain abscesses.
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Affiliation(s)
- Addie B Spier
- Division of Infectious Disease, Mercyhealth, Rockford, IL, USA
- Department of Medicine, University of Illinois College of Medicine, Rockford, IL, USA
| | - Diana David
- Department of Internal Medicine, Internal Medicine Residency Program, Mercyhealth, Rockford, IL, USA
| | - Moamen Al Zoubi
- Division of Infectious Disease, Mercyhealth, Rockford, IL, USA
- Department of Medicine, University of Illinois College of Medicine, Rockford, IL, USA
| | | | - Colin E Evans
- Department of Pediatrics, Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Rothman R, Saini V, Min Z, Bhanot N. Brain abscess associated with Mycoplasma faucium – The initial presentation of pulmonary arteriovenous malformation. IDCases 2022; 29:e01575. [PMID: 35865084 PMCID: PMC9294263 DOI: 10.1016/j.idcr.2022.e01575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 07/12/2022] [Accepted: 07/13/2022] [Indexed: 11/05/2022] Open
Abstract
Brain abscesses represent a pathology with significant morbidity and mortality. An underlying predisposing condition may not be apparent or identifiable in some instances. We present a patient with cerebral abscess who was found to have, previously undiagnosed, pulmonary arteriovenous malformations (PAVMs). PAVMs are rare pulmonary vascular anomalies resulting in intrapulmonary right to left shunt. These have been implicated in the development of brain abscesses. Conventional cultures from the lesion were non-revealing; hence, sample was sent for next-generation sequencing (NGS) which revealed multiple organisms, with predominance of Mycoplasma faucium, a bacterium initially felt to be a commensal of the oropharynx, but recently implicated as a human pathogen. This case, along with other documented associations between brain abscesses and pulmonary AVMs, highlights that brain abscess could be an initial clinical presentation in asymptomatic PAVMs. Additionally, novel testing such as NGS should be utilized in select settings where microbiological diagnosis can be elusive. This will help institute pathogen-directed specific antimicrobial therapy for favorable clinical outcomes.
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Gao LY, Xu GR, Dai TJ. Precision diagnosis and therapy of a case of brain abscesses associated with asymptomatic pulmonary arteriovenous fistulas. BMC Infect Dis 2020; 20:370. [PMID: 32448130 PMCID: PMC7247166 DOI: 10.1186/s12879-020-05092-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 05/14/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Brain abscesses, a severe infectious disease of the CNS, are usually caused by a variety of different pathogens, which include Streptococcus intermedius (S. intermedius). Pulmonary arteriovenous fistulas (PAVFs), characterized by abnormal direct communication between pulmonary artery and vein, are a rare underlying cause of brain abscesses. CASE PRESENTATION The patient was a previous healthy 55-year-old man who presented with 5 days of headache and fever. Cerebral magnetic resonance imaging (MRI) suggested a brain abscess. Thoracic CT scan and angiography demonstrated PAVFs. Aiding by metagenomic next-generation sequencing (mNGS) of the cerebrospinal fluid (CSF) sample which identified S. intermedius as the causative pathogen, the patient was switched to the single therapy of large dose of penicillin G and was cured precisely and economically. CONCLUSIONS It is an alternative way to perform mNGS to identify causative pathogens in patients with brain abscesses especially when the results of traditional bacterial culture were negative. Further thoracic CT or pulmonary angiography should also be undertaken to rule out PAVFs as the potential cause of brain abscess if the patient without any known premorbid history.
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Affiliation(s)
- Lu-Yao Gao
- Department of Emergency Medicine and Chest Pain Center, Qilu Hospital of Shandong University, Jinan, 250012, Shandong Province, China
| | - Guang-Run Xu
- Department of Neurology, Qilu Hospital of Shandong University, Jinan, 250012, Shandong Province, China
| | - Ting-Jun Dai
- Department of Neurology, Qilu Hospital of Shandong University, Jinan, 250012, Shandong Province, China.
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