A world in the head: Brain abscess caused by Paradoxical embolism due to pulmonary arteriovenous fistula as a debut of hereditary hemorrhagic telangiectasia


A world in the head: Brain abscess caused by Paradoxical embolism due to pulmonary arteriovenous fistula as a debut of hereditary hemorrhagic telangiectasia


Calle-Gómez, MI., Escobar- Sevilla, J., Domingo-Roa, S., Yagui Beltrán, S., Constan De la Revilla, E., Mediavilla García, JD.

Hospital Universitario Virgen de las Nieves. Granada


66-year-old patient with a history of alcoholism and smoking, chronic iron deficiency anemia treated with oral iron who was admitted for streptococcal brain abscess, during the etiological study we found arteriovenous shunt on echocardiography and pulmonary arteriovenous fistula, undergoing endovascular closure of the same during stay. In the physical examination, perioral teleangiectasis was observed, when meeting the Curaçao criteria, a genetic study of hereditary hemorrhagic teleangiectasia was requested, which was positive.


Learning points:
-Learning of risk factors for the acquisition of cranial abscess and its etiological study.
-Emphasize the paradoxical cause of systemic embolism.
-Study, screening and Treatment on AVM in hereditary hemorrhagic telangiectasia.


Keywords: Brain abscess; Paradoxical embolism; Pulmonary arteriovenous fistula; Rendu-osler-weber syndrome


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How to cite this article:

Calle-Gómez, MI., Escobar- Sevilla, J., Domingo-Roa, S., Yagui Beltrán, S., Constan De la Revilla, E., Mediavilla García, JD. A world in the head: Brain abscess caused by Paradoxical embolism due to pulmonary arteriovenous fistula as a debut of hereditary hemorrhagic telangiectasia. International Journal of Case Reports, 2020; 4:184. DOI: 10.28933/ijcr-2020-11-1706


References:

1. Shovlin CL, Jackson JE, Bamford KB, Jenkins IH, Benjamin AR, Ramadan H, Kulinskaya E. Primary determinants of ischaemic stroke/brain abscess risks are independent of severity of pulmonary arteriovenous malformations in hereditary haemorrhagic telangiectasia. Thorax. 2008 Mar;63(3):259-66. doi: 10.1136/thx.2007.087452. Epub 2007 Nov 2. PMID: 17981912.
2. Kawano H, Hirano T, Ikeno K, Fuwa I, Uchino M. Brain abscess caused by pulmonary arterioven- ous fistulas without Rendu-Osler-Weber disease. Intern Med. 2009;48(6):485-7. doi: 10.2169/internalmedicine.48.1678. Epub 2009 Mar 16. PMID: 19293552.
3. Corvino F, Silvestre M, Cervo A, Giurazza F, Corvino A, Maglione F. Endovascular occlusion of pulmonary arteriovenous malformations with the ArtVentive Endoluminal Occlusion System™. Diagn Interv Radiol. 2016;22(5): 463-465. doi: 10.5152/dir.2016.15620
4. Mejía ARR, Fuertes MY, Moya MJ. Brain Abscess in a Patient with Rendu-Osler-Weber Syndrome: Value of Proton Magnetic Resonance Spectroscopy. NMC Case Rep J. 2016;3(2):35-37. Published 2016 Feb 5. doi:10.2176/nmccrj.cr.2015-0141
5. Boother EJ, Brownlow S, Tighe HC, Bamford KB, Jackson JE, Shovlin CL. Cerebral Abscess Associated With Odontogenic Bacteremias, Hypoxemia, and Iron Loading in Immunocom- petent Patients With Right-to-Left Shunting Through Pulmonary Arteriovenous Malformati- ons. Clin Infect Dis. 2017 Aug 15;65(4):595-603. doi: 10.1093/cid/cix373. PMID: 28430880; PMCID: PMC5849101.
6. Etievant J, Si-Mohamed S, Vinurel N, Dupuis-Girod S, Decullier E, Gamondes D, Khouatra C, Cottin V, Revel D. Pulmonary arteriovenous malformations in hereditary haemorrhagic telangiectasia: Correlations between computed tomography findings and cerebral complications. Eur Radiol. 2018 Mar;28(3):1338-1344. doi: 10.1007/s00330-017-5047-x. Epub 2017 Oct 10. PMID: 29018941.