title: A cerebral abscess at first internist glance.
abstract: A 73-year-old man was transferred to the neurosurgery ward, with a presumptive diagnosis of cerebral abscess. The case was also discussed with the internists as internal medicine consultants. The neurosurgeons pointed out a right temporal lobe abscedated lesion on CT, but we noticed that the hypodense attenuation that usually surrounds the abscess wall (vasogenic oedema) extended to a broader, well-delimitated area, suggesting medium cerebral artery territory. The patient had left-sided hemiplegia with a confusional state and low-grade fever. Considering possible haematogenous dissemination, an echocardiography was performed, confirming mitral endocarditis. Blood cultures and aspirated pus isolated Escherichia coli. Investigating the patient's medical history, we learned he had been submitted to bladder catheterisation 7 weeks before for acute urinary retention due to benign prostatic hyperplasia, and empirically medicated for urinary tract infection. E. coli had also been isolated in a urine specimen at the time. The clinical history of the patient cancelled the pathogenesis of cerebral abscess.
authors.affiliation: Department of Internal Medicine, Hospital de Santo António dos Capuchos, Lisboa, Portugal.
authors.forename: Rita
authors.initials: R
authors.lastname: Ribeiro
authors.affiliation: Department of Internal Medicine, Hospital de Santo António dos Capuchos, Lisboa, Portugal.
authors.forename: Catarina
authors.initials: C
authors.lastname: Patrício
authors.affiliation: Department of Dermatology, Hospital de Santo António dos Capuchos, Lisboa, Portugal.
authors.forename: Margarida Moura
authors.initials: MM
authors.lastname: Valejo Coelho
authors.affiliation: Department of Internal Medicine, Hospital de Santo António dos Capuchos, Lisboa, Portugal.
authors.forename: Vítor
authors.initials: V
authors.lastname: Brotas
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001922:Brain Abscess / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D003937:Diagnosis, Differential; D004697:Endocarditis, Bacterial / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D004927:Escherichia coli Infections / Q000175:diagnosis* / Q000188:drug therapy; D006801:Humans; D008297:Male; D008943:Mitral Valve / Q000382:microbiology*; D014552:Urinary Tract Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology
chemical_list: D000900:Anti-Bacterial Agents