case_images: PMC9910333_01
case_images: Clinical manifestation of bilateral thighs abscesses. (A) Bulging mass on the right thigh. (B) Bulging mass on the left thigh. (C) Brown fetid pus was aspirated by computed tomography (CT)-guided percutaneous puncture in right thigh abscess.
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case_images: F1
case_images: In addition, bumps were found on his left thigh (21 cm x 13 cm) (Figure 1A), right thigh (22 cm x 12 cm) (Figure 1B), and backside (7 cm x 3 cm) with tenderness and fluctuation. CSF samples were both performed. CT-guided percutaneous catheter drainage of abscesses was performed in both thighs, and brown fetid pus was aspirated (Figure 1C).
case_images: Computed tomography (CT) scan result of bilateral lower extremities and timeline of treatment. (A) CT scan shows multiple muscle abscesses in bilateral thighs. (B) Right thigh abscess. (C) Left thigh abscess. (D) Timeline of treatment.
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case_images: F2
case_images: Computed tomography (CT) of both lower extremities showed the presence of multiple hypodense lesions, which indicated multiple muscle abscesses in the right vastus intermedius, left vastus lateralis muscle, and left adductor magnus (Figures 2A-C). The timeline of the treatment is shown in Figure 2D.
case_images: Magnetic resonance image (MRI) of brain shows abscesses in bilateral frontal lobe, right temporo-parieto-occipital lobe, and right cerebellar hemisphere with ring contrast enhancement and perilesional edema. (A,B,G) T2-weighted imaging. (C,D,H) T2 contrast-enhancement imaging. (E,F) Diffusion-weighted MRI.
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case_images: F3
case_images: Brain magnetic resonance imaging (MRI) showed rim-enhancing lesions with perilesional edema that indicated bilateral brain abscesses in the frontoparietal lobe, right temporal occipital lobe, and right cerebellar hemisphere (Figure 3). Brain MRI also showed heterogeneously thickened dura with peripheral rim enhancement, which indicated dura empyema on the right frontoparietal lobe (Figure 3). Diffusion-weighted MRI shows a hyperintense signal within these lesions (Figure 3).
case_images: Metagenomic next-generation sequencing (mNGS) results of this case. (A) Courage of Porphyromonas gingivalis detected by mNGS was 79.4279%. (B) A total of 60853 specific reads of P. gingivalis were detected by mNGS in this case.
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case_images: F4
case_images: Bacteroides heparinolyticus (892 specific reads), and Tannerella forsythia (317 specific reads) were detected on day 3 (Figure 4). Blood and CSF samples were also used to detect pathogens using the method of the