Neurology, King Fahad Medical City, Riyadh, Saudi Arabia
Internal Medicine, Infectious Diseases, King Fahad Medical City, Riyadh, Saudi Arabia.
BMJ Case Rep. 2023 May 23;16(5):e250787. doi: 10.1136/bcr-2022-250787.
A right-handed man in his early 60s with hypertension controlled by a single prescription medication presented with left-sided heaviness and intermittent right occipital headache. Initial diagnostic workup was unremarkable. CT revealed an enhancing lesion located in the right parietal lobe, with mild mass effect on the right occipital horn, indicative of a brain abscess. The patient was initially treated with a course of empirical antibiotics, including ceftriaxone, vancomycin, metronidazole and dexamethasone. The neurosurgery team aspirated the abscess the following day and extracted yellow pus that was sampled for bacterial and fungal cultures. These cultures returned positive for , prompting a discontinuation of the empirical antibiotics and initiation of intravenous liposomal amphotericin B for 4 weeks. Intravenous posaconazole was added to the patient's existing therapy regimen, which was substituted with oral isavuconazole on discharge. The patient continues to take isavuconazole, and follow-up imaging has demonstrated regression of the abscess.
一位 60 岁出头的惯用右手男性，患有高血压，仅服用一种处方药进行控制，他主诉左侧肢体沉重，间歇性右侧枕部头痛。初步诊断性检查未见异常。CT 显示右侧顶叶有一个增强病变，右侧枕角有轻度占位效应，提示为脑脓肿。患者最初接受了一个疗程的经验性抗生素治疗，包括头孢曲松、万古霉素、甲硝唑和地塞米松。神经外科团队在第二天抽吸了脓肿，并抽取了黄色脓液进行细菌和真菌培养。这些培养物结果呈阳性，促使停止使用经验性抗生素，并开始静脉注射脂质体两性霉素 B 4 周。静脉注射泊沙康唑被添加到患者现有的治疗方案中，出院时用口服伊曲康唑替代。患者继续服用伊曲康唑，随访影像学显示脓肿消退。
