Multiple Brain Abscesses: An Unusual Case

Document Type : Case Report


1 Department of Neurology, School of Medicine, Non Communicable Disease Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran

2 Department of Radiology, School of Medicine, Rafsanjan University of Medical Sciences, Rafsanjan, Iran

3 Department of Pathology, School of Medicine, Rafsanjan University of Medical Sciences, Rafsanjan, Iran

4 Radiology Resident, Rafsanjan University of Medical Sciences, Rafsanjan, Iran

5 Student Research Committee, Faculty of Medicine, Qom University of Medical Sciences, Qom, Iran


Brain abscess is a collection of pus with a vascular capsule beginning as a cerebritis at its early stage. The incidence rate of brain abscess is approximately 0.13-0.9 per 100,000 person-year. In 33% of cases, brain abscess is spread hematogenously, mostly with endocarditis (13%), pulmonary infection (8%), or dental infection (5%). Other cases are attributed to recent neurosurgeries (9%) or cranial traumas (14%). Streptococcus and Staphylococcus species are the most common microorganisms causing brain abscesses. The symptoms presented include headache, fever, nausea, vomiting, focal neurologic symptoms, lethargy, and seizure. In this study, a 44-year-old coal worker methadone-abuser man who was admitted with the presentation of altered mental status, headache, imbalance, and vertigo with widespread ring-enhancing lesions in his brain caused by multiple brain abscesses due to solitary lung abscess without pulmonary disease symptoms is reported. Altered consciousness and dysphagia were considered as a cause for his aspiration.


  1. Kragha KO. Multiple Brain Abscesses due to Streptococcus anginosus: Prediction of Mortality by an Imaging Severity Index Score. Case Rep Radiol. 2016; 2016: 7040352. doi: 10.1155/2016/7040352.
  2. Sonneville R, Ruimy R, Benzonana N, Riffaud L, Carsin A, Tadié JM, et al. ESCMID Study Group for Infectious Diseases of the Brain (ESGIB). An update on bacterial brain abscess in immunocompetent patients. Clin Microbiol Infect. 2017; 23(9): 614-20. doi: 10.1016/j.cmi.2017.05.004.
  3. Brouwer MC, Coutinho JM, van de Beek D. Clinical characteristics and outcome of brain abscess: systematic review and meta-analysis. Neurology. 2014; 82(9): 806-13. doi: 10.1212/WNL.0000000000000172.
  4. Lakshmi V, Umabala P, Anuradha K, Padmaja K, Padmasree C, Rajesh A, et al. Microbiological spectrum of brain abscess at a tertiary care hospital in South India: 24-year data and review. Patholog Res Int. 2011; 2011: 583139. doi: 10.4061/2011/583139.
  5. Muzumdar D, Jhawar S, Goel A. Brain abscess: an overview. Int J Surg. 2011; 9(2):136-44. doi: 10.1016/j.ijsu.2010.11.005.
  6. Bokhari MR, Mesfin FB. Brain Abscess. 2021 Sep 15. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing ;2022. PMID: 28722871.
  7. Patel K, Clifford DB. Bacterial brain abscess. Neurohospitalist. 2014; 4(4):196-204. doi: 10.1177/1941874414540684.
  8. Ribeiro R, Patrício C, Valejo Coelho MM, Brotas V. A cerebral abscess at first internist glance. BMJ Case Rep. 2015; 2015: bcr2015212162. doi: 10.1136/bcr-2015-212162.
  9. Ahmad R. Neurocysticercosis and starry sky appearance on brain imaging. QJM. 2020; 113(4): 283. doi: 10.1093/qjmed/hcz185.
  10. Ataka T, Kimura N, Matsubara E. A case of myelin oligodendrocyte glycoprotein-antibody-associated disease presenting with tumefactive demyelinating lesion. Mult Scler Relat Disord. 2020; 43:102191. doi: 10.1016/j.msard.2020.102191.
  11. Suzuki T, Okamoto K, Genaki N. A Homogeneously enhancing mass evolving into multiple hemorrhagic and necrotic lesions in amoebic encephalitis with necrotizingvasculitis. Clin Imaging. 2020; 60(1):48-52. doi: 1016/j.clinimag.2019.10.015.
  12. Lee GT, Antelo F, Mlikotic AA. Best cases from the AFIP: cerebral toxoplasmosis. Radiographics. 2009; 29(4): 1200-5. doi: 10.1148/rg.294085205.
  13. Straehley I, Varada N, Prokop I, Muxen C. Horner Syndrome induced by toxoplasmosis infection in a patient with AIDS and disseminated herpes simplex virus. Am J Ophthalmol Case Rep. 2020; 18: 100679. doi: 10.1016/j.ajoc.2020.100679.