A 56-YEAR-OLD WOMAN was admitted for nausea and projectile vomiting of several days' duration. A review of her medical history failed to provide significant information, and the physical examination showed only marked obesity. During the course of the patient's workup, a computed tomographic scan of her head indicated 2 ring-enhancing lesions in the frontal and parietal lobes of the brain, each 2.5 cm in greatest dimension and reported as being consistent with metastases. The patient was transferred to the neurosurgical service, where she suddenly died. An autopsy was requested by the physician with the goal of determining the primary site of the patient's presumed carcinoma.
Postmortem fine-needle aspiration biopsy of the cerebral lesions showed only neutrophils and necrotic debris. Cerebral herniation was evident. Subsequent histological study indicated that the lesions were abscesses not metastases. An assiduous postmortem search for a source of infection revealed suppurative gingivitis and no
Davis GJ, Hanzlick R. Case of the Month. Arch Intern Med. 1997;157(20):2296. doi:10.1001/archinte.1997.00440410022002