International medical case reports journal
Clinical Recovery Following Conservative Management of a Large Presumed Brain Abscess with a Concomitant Streptococcus intermedius Lung Abscess in a Severely Malnourished Young Adult in a Resource-Limited Setting: A Case Report
By Riesehaymanot FT, Zeray EH and Tekeste LM.
Abstract
Background
Brain abscess is a life-threatening condition requiring prompt antimicrobial therapy and, when feasible, neurosurgical drainage. Management can be particularly challenging in resource-limited settings where neurosurgical intervention, microbiological confirmation, and follow-up imaging may be unavailable. We report a case of a large presumed brain abscess occurring concurrently with a Streptococcus intermedius lung abscess in a severely malnourished young adult managed in a resource-limited setting.
Case presentation
A 22-year-old Eritrean man presented with one week of progressive left-sided weakness preceded by four weeks of productive cough, fever, and weight loss. He was severely malnourished (BMI 14 kg/m2), febrile, and had impaired consciousness with flaccid left hemiplegia. Non-contrast CT and MRI showed a 4 × 3 cm right parietal intracranial lesion with surrounding edema and moderate midline shift, presumed to represent a brain abscess. Chest imaging revealed a right lower-lobe lung abscess, from which Streptococcus intermedius was isolated; blood cultures were negative and echocardiography was normal. Neurosurgical drainage was unavailable. He was treated with intravenous ceftriaxone and metronidazole with supportive and nutritional care. His GCS improved from 10/15 to 15/15 within three days, and he regained independent ambulation by four weeks. He completed four weeks of intravenous antibiotics and was discharged clinically stable with oral antibiotics to complete seven weeks of antibiotics. No follow-up neuroimaging was available, but he remained clinically well during three years of telephone follow-up.