Publication details

Polymikrobieller Hirnabszess bei hereditärer hämorrhagischer Teleangiektasie (Morbus Osler).

Title in English Polymicrobial brain abscess in hereditary haemorrhagic telangiectasia (Osler’s disease)
Authors

POLÁK Pavel SNOPKOVÁ Svatava HUSA Petr

Year of publication 2012
Type Article in Periodical
Magazine / Source Deutsche medizinische Wochenschrift
MU Faculty or unit

Faculty of Medicine

Citation
Doi http://dx.doi.org/10.1055/s-0032-1305184
Field Epidemiology, infectious diseases and clinical immunology
Keywords hereditary haemorrhagic teleangiectasia; brain abscess; pulmonary arterivenous malformation
Description History and admission findings: A 38-year-old woman who suffered from migraine was admitted because of severe, worsening headache for 24 hours (dissimilar to the previous migraine attacks), with impaired vision and weakness of the right arm. Mild hemiparesis and expressive aphasia indicated an intracranial tumor. Investigations: Cranial computed tomography revealed a focal lesion with a diameter of 2.5 cm in the left frontoparietal lobe, with signs of intracranial hypertension, indicating cerebral metastasis or an abscess. Magnetic resonance imaging confirmed the diagnosis of a brain abscess Treatment and course: An urgent craniotomy was performed and the abscess was evacuated. An empirical antibiotic combination with chloramphenicole and metronidazole (switched to cefotaxime because of thrombocytopenia) was initiated. Cultivation of pus revealed Streptococcus constellatus, Aggregatibacter aphrophilus and Fusobacterium spp. Within the first two weeks of treatment progession of the abscess was noted, therefore a second craniotomy with debridement was performed. An elective CT-angio scan revealed several arteriovenous malformations in the caudal segments of both lungs which were embolized without complications. Only retrospectively, cutaneous teleangiectasias were recognized. At present, the patient and her direct relatives are submitted to genetical screening for Osler‘ s disease. Conclusion: In patients with brain abscesses of unknown origin and with a history of repeated epistaxis and/or gastrointestinal bleeding, Osler‘s disease (hereditary hemorrhagic telangiectasia) should be considered and pulmonary arteriovenous malformations excluded. Physicians should search for cutaneous or mucous teleangiectasias. Family screening and long-term follow- up according to international guidelines is recommended.

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