Clinical Recovery Following Conservative Management of a Large Presumed Brain Abscess with a Concomitant Streptococcus intermedius Lung Abscess in a Severely Malnourished Young Adult in a Resource-Limited Setting: A Case Report.
Filmon Tesfay Riesehaymanot, Estifanos Habteab Zeray, Lidya Musie Tekeste
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Case in brief
A severely malnourished 22-year-old man presented with progressive left-sided weakness after weeks of productive cough, fever, and weight loss. Examination showed impaired consciousness and flaccid hemiplegia. Brain imaging demonstrated a 4 × 3 cm right parietal lesion with edema and moderate midline shift, presumed to be an abscess; chest imaging showed a right lower-lobe abscess yielding Streptococcus intermedius. Blood cultures were negative, and echocardiography was normal. With neurosurgical drainage unavailable, he received intravenous ceftriaxone and metronidazole plus supportive and nutritional care. Consciousness improved within three days, and he walked independently by four weeks. He remained clinically well during three years of telephone follow-up, without follow-up brain imaging.
What made this case unusual
A large presumed brain abscess with substantial mass effect was managed without neurosurgical drainage in a resource-limited setting, alongside a Streptococcus intermedius lung abscess. The brain lesion was not microbiologically confirmed, and clinical recovery could not establish radiological resolution.
Diagnostic / clinical pearl
A concurrent lung abscess can provide a microbiological clue when a brain lesion is presumed to be an abscess, but isolation of Streptococcus intermedius from the lung does not confirm the brain lesion’s cause. Clinical improvement alone does not demonstrate radiological resolution.
Why it matters
The case highlights the constraints of managing suspected brain abscess when drainage and follow-up imaging are unavailable, while underscoring that resource-adapted care does not replace neurosurgical management when feasible.