title: Sinus venosus atrial septal defect presenting with brain abscesses in a 77-year-old immunocompetent patient.
abstract: We present a case of 77-year-old immunocompetent patient who initially presented with vertigo, nausea and vomiting, with symptoms later progressing to headaches and increased lethargy. Brain MRI revealed ring-enhancing lesions typical of abscesses in the right cerebellum. Transoesophageal echocardiogram (TEE) was performed to look for the source of his abscesses, and uncovered a sinus venosus type atrial septal defect. Cardiac CT was carried out; the patient was found to have a sinus venosus atrial septal defect with partial anomalous pulmonary venous return. Moreover, dental examination showed multiple dental caries with poor oral hygiene. The patient was started on intravenous empiric antibiotics and steroids. Subsequent brain imaging showed almost complete resolution of the abscesses. The patient's symptoms started to improve, and he was eventually sent to an intensive rehabilitation centre with future plans to surgically correct his congenital heart disease to prevent further complications.
authors.affiliation: Department of Internal Medicine, Einstein Medical Center, Philadelphia, Pennsylvania, USA.
authors.forename: Yaser S M
authors.initials: YS
authors.lastname: Alhamshari
authors.affiliation: Department of Internal Medicine, Einstein Medical Center, Philadelphia, Pennsylvania, USA.
authors.forename: Chitra
authors.initials: C
authors.lastname: Punjabi
authors.affiliation: The Institute for Heart and Vascular Health and Cardiovascular Diseases, Einstein Medical Center, Philadelphia, Pennsylvania, USA.
authors.forename: Gregg S
authors.initials: GS
authors.lastname: Pressman
authors.affiliation: Department of Internal Medicine, Einstein Medical Center, Philadelphia, Pennsylvania, USA.
authors.forename: Anita
authors.initials: A
authors.lastname: Govil
mesh_terms: D000368:Aged; D054087:Atrial Septum; D001922:Brain Abscess / Q000175:diagnosis* / Q000209:etiology; D057210:Delayed Diagnosis; D003731:Dental Caries / Q000209:etiology; D017548:Echocardiography, Transesophageal; D006344:Heart Septal Defects, Atrial / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D006801:Humans; D011667:Pulmonary Veins