PMC8645497_01
(a) A non-contrast head computed tomography on admission showing a mass lesion with edema in the left frontal lobe. (b) A non-contrast T1-weighted magnetic resonance (MR) image showing a mass lesion in the left frontal lobe. (c) A gadolinium-enhanced MR image showing a ring-enhancement. (d) A diffusion-weighted image (without gadolinium) showing a significant restriction of diffusion in the lesion.
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F1
Head computed tomography (CT) on admission showed a mass lesion with brain edema in the left frontal lobe [Figure 1a]. Gadolinium-enhanced magnetic resonance imaging (MRI) revealed a mass in the frontal lobe with ring-enhancement while diffusion-weighted imaging (DWI) showed significant diffusion restriction, leading to the diagnosis of a brain abscess [Figure 1b-d].
Transesophageal echocardiogram bubble study showing air bubbles (arrow). RA: the right atrium, LA: the left atrium, Ao: the aorta.
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F2
However, a transesophageal echocardiogram (TEE) bubble study (based on bubbles detected in the left atrium) revealed several reproducible bubbles within a three-heartbeat span in the left ventricular system, suggesting the presence of a Grade 1, mild PFO [Figure 2].
The inflammatory response level and duration of antibiotic use during treatment. CRP: C-reactive protein, ESR: Erythrocyte sedimentation rate, WBC: White blood cell.
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F3
After detecting P. intermedia, along with the results of sensitivity testing to antibiotics, piperacillin-tazobactam and metronidazole were used [Figure 3]. One and a half months after discharge, the antibiotic was terminated (since the erythrocyte sedimentation rate was normalized) and a head MRI showed a further reduction in abscess size [Figure 3].