Brain Abscess in Alcoholic Male

A 45 year old male presented with generalized tonic clonic seizures. At presentation, vitals were stable, the patient was unconcious with flexor limb response to painful stimuli, there were no signs of meningitis; systemic examination was normal. A MRI Brain obtained at another facility prior to presentation showed a left sided subcortical brain abscess. Hemogram, liver function tests and serum creatinine were within normal limits. The chest radiograph showed a markedly elevated diaphragm.

The patient had a history of chronic alcoholism, with binge drinking prior to presentation. He had a history of smear positive pulmonary tuberculosis 18 months prior; details of treatment adherence and completion were not available.

The patient underwent a burr hole drainage of the brain abscess. Gram and acid-fast stains on the pus specimen showed no organisms. GeneXpert MTB RIF and bacterial cultures were negative.

A CT abdomen revealed a large subcapsular liver abscess, with rupture and extension into the right pleural cavity. A percutaneous catheter was inserted under ultrasound guidance. Gram stains, acid-fast stain, bacterial cultures and GeneXpert were negative on the aspirated fluid. Cytology showed necrotic material.

Amebic liver abscess with metastatic brain abscess was diagnosed. The patient completed 3 weeks of IV metronidazole. At discharge from hospital, the patient was concious, ambulatory without any residual neurologic deficits.

Amebic Liver Abscess with Metastatic Brain Abscess