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.
- 1Department of Internal Medicine, Keren Zonal Referral Hospital, Keren, Anseba Region, Eritrea.
- 2Department of Internal Medicine, Tesseney Hospital, Tesseney, Gash Barka Region, Eritrea.
- 3Department of Emergency, Afabet Hospital, Afabet, Northern Red Sea Region, Eritrea.
Abstract
Background
Brain abscess is a life-threatening condition requiring prompt antimicrobial therapy and, when feasible, neurosurgical drainage. Management can be particularly challenging in resource-limited settings where neurosurgical intervention, microbiological confirmation, and follow-up imaging may be unavailable. We report a case of a large presumed brain abscess occurring concurrently with a Streptococcus intermedius lung abscess in a severely malnourished young adult managed in a resource-limited setting.Case presentation
A 22-year-old Eritrean man presented with one week of progressive left-sided weakness preceded by four weeks of productive cough, fever, and weight loss. He was severely malnourished (BMI 14 kg/m²), febrile, and had impaired consciousness with flaccid left hemiplegia. Non-contrast CT and MRI showed a 4 × 3 cm right parietal intracranial lesion with surrounding edema and moderate midline shift, presumed to represent a brain abscess. Chest imaging revealed a right lower-lobe lung abscess, from which Streptococcus intermedius was isolated; blood cultures were negative and echocardiography was normal. Neurosurgical drainage was unavailable. He was treated with intravenous ceftriaxone and metronidazole with supportive and nutritional care. His GCS improved from 10/15 to 15/15 within three days, and he regained independent ambulation by four weeks. He completed four weeks of intravenous antibiotics and was discharged clinically stable with oral antibiotics to complete seven weeks of antibiotics. No follow-up neuroimaging was available, but he remained clinically well during three years of telephone follow-up.Conclusion
This case illustrates the challenges of managing a large presumed brain abscess when neurosurgical drainage and follow-up neuroimaging are unavailable. Despite the absence of microbiological confirmation from the brain lesion, the patient achieved sustained clinical and neurological recovery following prolonged antimicrobial and supportive treatment. The case emphasizes diagnostic vigilance and resource-adapted care while recognizing that clinical recovery does not establish radiological resolution or replace standard neurosurgical management when feasible.
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BibTeX
@article{riesehaymanot2026clinical,
title = {{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.}},
author = {Filmon Tesfay Riesehaymanot and Estifanos Habteab Zeray and Lidya Musie Tekeste},
journal = {International medical case reports journal},
year = {2026},
month = oct,
doi = {10.2147/imcrj.s635618},
url = {https://europepmc.org/article/MED/42921506},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - 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.
AU - Filmon Tesfay Riesehaymanot
AU - Estifanos Habteab Zeray
AU - Lidya Musie Tekeste
PY - 2026
DA - 2026/10/19
JO - International medical case reports journal
DO - 10.2147/imcrj.s635618
UR - https://europepmc.org/article/MED/42921506
AB - Background Brain abscess is a life-threatening condition requiring prompt antimicrobial therapy and, when feasible, neurosurgical drainage. Management can be particularly challenging in resource-limited settings where neurosurgical intervention, microbiological confirmation, and follow-up imaging may be unavailable. We report a case of a large presumed brain abscess occurring concurrently with a Streptococcus intermedius lung abscess in a severely malnourished young adult managed in a resource-limited setting.Case presentation A 22-year-old Eritrean man presented with one week of progressive left-sided weakness preceded by four weeks of productive cough, fever, and weight loss. He was severely malnourished (BMI 14 kg/m²), febrile, and had impaired consciousness with flaccid left hemiplegia. Non-contrast CT and MRI showed a 4 × 3 cm right parietal intracranial lesion with surrounding edema and moderate midline shift, presumed to represent a brain abscess. Chest imaging revealed a right lower-lobe lung abscess, from which Streptococcus intermedius was isolated; blood cultures were negative and echocardiography was normal. Neurosurgical drainage was unavailable. He was treated with intravenous ceftriaxone and metronidazole with supportive and nutritional care. His GCS improved from 10/15 to 15/15 within three days, and he regained independent ambulation by four weeks. He completed four weeks of intravenous antibiotics and was discharged clinically stable with oral antibiotics to complete seven weeks of antibiotics. No follow-up neuroimaging was available, but he remained clinically well during three years of telephone follow-up.Conclusion This case illustrates the challenges of managing a large presumed brain abscess when neurosurgical drainage and follow-up neuroimaging are unavailable. Despite the absence of microbiological confirmation from the brain lesion, the patient achieved sustained clinical and neurological recovery following prolonged antimicrobial and supportive treatment. The case emphasizes diagnostic vigilance and resource-adapted care while recognizing that clinical recovery does not establish radiological resolution or replace standard neurosurgical management when feasible.
SN - 1179-142X
ER -