Rothman Ryan, Saini Vikram, Min Zaw, Bhanot Nitin
Allegheny General Hospital, Allegheny Health Network, PA 15212, the United States of America.
IDCases. 2022 Jul 14;29:e01575. doi: 10.1016/j.idcr.2022.e01575. eCollection 2022.
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 , 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.
脑脓肿是一种具有显著发病率和死亡率的病理学疾病。在某些情况下，潜在的诱发因素可能并不明显或无法识别。我们报告一名患有脑脓肿的患者，该患者被发现此前未被诊断出患有肺动静脉畸形（PAVM）。肺动静脉畸形是罕见的肺血管异常，导致肺内右向左分流。这些异常与脑脓肿的发生有关。病变部位的传统培养未发现病原体；因此，样本被送去进行二代测序（NGS），结果显示有多种微生物，其中以 为主，这种细菌最初被认为是口咽部的共生菌，但最近被认为是一种人类病原体。该病例以及其他已记录的脑脓肿与肺动静脉畸形之间的关联表明，脑脓肿可能是无症状肺动静脉畸形的初始临床表现。此外，在微生物诊断难以确定的特定情况下，应采用如二代测序等新型检测方法。这将有助于制定针对病原体的特异性抗菌治疗方案，以获得良好的临床结果。
