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case_images: Initial laboratory tests.
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case_images: Lab tests were significant for a white blood cell (WBC) count of 10 100/mm3, hemoglobin of 12.2 g/dL, platelet count of 262 000/mm3, creatinine of 0.63 mg/dL, lactic acid of 0.8 mmol/L, Hgb A1c of 5.4%, erythrocyte sedimentation rate (ESR) of 130 mm/h, c-reactive protein (CRP) of 18.925 mg/dL, and HIV antigen/antibody nonreactive (Figure 1).
case_images: (A) MRI brain with and without IV contrast showing a right parietal-occipatal lobe brain abscess (red arrow) with vasogenic edema (orange arrow). (B) MRI brain with and without IV contrast showing post-surgical changes and edema (red arrow) at the right parietal burr hole without evidence of residual right parietal-occipital brain abscess.
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case_images: Magnetic resonance imaging (MRI) brain confirmed a right parietal-occipital lobe abscess with vasogenic edema (Figure 2A). His renal function and eosinophilia improved; repeat TEE and MRI of the brain performed 7 weeks after the beginning of antibiotic treatment showed completed radiographic resolution of his cerebral abscess and aortic valve vegetation (Figures 2B and 5B).
case_images: Gram stain from brain abscess showing thin fusiform gram-negative rods.
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case_images: His cerebral abscess cultures grew F nucleatum (Figure 3) and infectious disease (ID) service was consulted for antibiotic recommendations.
case_images: MRI liver shows a 5 x 5.5-cm subcapsular lesion in the anterosuperior subsegment of the right lobe (red arrow) and a 4.5 x 5-cm lesion in medial superior subsegment of the left lobe with an exophytic component and mild surrounding inflammation.
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case_images: The MRI liver imaging confirmed 2 sizable intrahepatic abscesses, each 5 cm in size (Figure 4).
case_images: (A) Transesophageal echocardiogram showing a 1 cm vegetation on the aortic valve (red arrow). (B) Repeat transesophageal echocardiogram showing resolution of aortic valve vegetation after antibiotic treatment.
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case_images: Follow-up transesophageal echocardiogram (TEE) detected a 1-cm mobile vegetation on the aortic valve (Figure 5A). His renal function and eosinophilia improved; repeat TEE and MRI of the brain performed 7 weeks after the beginning of antibiotic treatment showed completed radiographic resolution of his cerebral abscess and aortic valve vegetation (Figures 2B and 5B).