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JAMA Cardiology Clinical Challenge
September 26, 2018

Brain Abscess in an Adult Patient With Congenital Heart Disease

Author Affiliations
  • 1Brown University, Department of Medicine, Rhode Island Hospital, Providence
JAMA Cardiol. 2019;4(2):184-185. doi:10.1001/jamacardio.2018.3003

A 63-year-old woman with atrial fibrillation, who was receiving warfarin and had a history of atrial septal defect (ASD) and ventricular septal defect (VSD) repair in her 20s, presented with stupor and new facial droop. A computed tomographic examination of the brain showed a right frontal lobe abscess with vasogenic edema (Figure 1). She underwent burrhole aspiration of the abscess, which grew mixed oral flora. Treatment involved a prolonged course of intravenous antibiotics, steroids, and medications for seizure prophylaxis.

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