Multiple brain abscesses in a patient with bilateral pulmonary arteriovenous malformations and immunoglobulin deficiency

Abstract

A 34 year old Chinese man presented with grand mal seizures complicating multiple brain abscesses caused by mixed oral flora. Because of persistent hypoxaemia contrast spiral thoracic computed tomography was done, which revealed bilateral pulmonary arteriovenous malformations (PAVMs). Concomitant IgA and IgG subclass deficiency was also found. The combination of these two conditions appears to have predisposed this patient to presumably paradoxical septic embolism. The patient’s cerebral condition responded to postoperative antibiotic treatment and he eventually received selective coil embolisation of right lower lobe PAVMs, which relieved his hypoxaemia and dyspnoea.

Subphrenic abscess and recurring focal lesions due to tuberculosis in a patient with IgA deficiency

“…18 Also, there was a case of multiple brain abscesses appeared in a patient with bilateral pulmonary arteriovenous malformations and concomitant IgA and IgG subclass deficiency. 16 Remaining of local and radiological signs of subdiaphragmatic abscess in spite of receiving anti-TB drugs which improved patient's general condition and resolved his lymphadenopathy were the unusual characteristics of the disease.…”

“…The majority of them remain asymptomatic, but some patients might develop sinopulmonary infections, chronic diarrheal illness and autoimmune phenomena. 16 There are some reports about formation of brain abscesses in the presence Figure 1 Abdominal CT shows left and right subphrenic abscesses (left), brain MRI was suggestive for parietal abscess (right). of selective IgA deficiency.…”

Patent foramen ovale: the current state of play

“…Paradoxical infections are well recognised complications among children with congenital intracardiac shunts or adult patients with pAVMs42 Similarly, cerebral abscesses have been reported in patients with sepsis with a previously silent PFO 43…”

Selective IGA Deficiency in a Child Presenting with Bilateral Septic Emboli

“…Selektif IgA eksikliği, bazen alerjik bozukluklar ve otoimmün hastalıklar ile ilişkili olabilir (11). Literatürde, yalnızca bir olguda, beyin absesi ile ilişkili olarak septik emboli belirlenmiş ve altta yatan sebep olarak selektif IgA eksikliği gösterilmiştir (12). Sunulan olguda belirlenen selektif Ig A eksikliğinin stafi lokokkal enfeksiyonu tetikleyerek emboli oluşumunu kolaylaştıracağı düşünülebilir.…”