Brain abscess as an initial presentation in a patient of hereditary haemorrhagic telangiectasia caused by a novel ENG mutation
Journal
BMJ Case Reports
Date Issued
2013
Author(s)
Abstract
Hereditary haemorrhagic telangiectasia (HHT) is a rare inherited autosomal-dominant vascular dysplasia involving multiple organs. Brain abscess is an uncommon and potential fatal complication. We report a case of HHT caused by a novel ENG mutation who initially presented as brain abscess. The patient, with a family history of epistaxis, presented with fever, headache and right-sided haemiparesis. Upon examination, brain MRI showed a contrast-enhanced abscess on the left fronto-parietal region. Open brain drainage was performed and pus culture yielded Actinomyces meyeri. The chest image revealed multiple pulmonary arterio-venous fistulas. HHT was diagnosed according to Curacao criteria. Genetic analysis revealed a novel duplication on exon 6 of ENG gene, which segregates with symptomatic subjects in her family. Clinicians should be cautiously aware of HHT as a differential diagnosis if patients presented with an unknown entry source of intracerebral infections. Copyright 2013 BMJ Publishing Group. All rights reserved.
SDGs
Other Subjects
ceftriaxone; metronidazole; ACVRL1 gene; adult; article; brain abscess; case report; clinical feature; congenital blood vessel malformation; differential diagnosis; DNA extraction; ENG gene; epistaxis; facial nerve paralysis; family history; female; fever; follow up; gene; gene amplification; gene duplication; gene mutation; gene sequence; headache; human; limb weakness; liver arteriovenous fistula; liver disease; medical history; neurologic examination; nuclear magnetic resonance imaging; polymerase chain reaction; priority journal; pulmonary arteriovenous fistula; recurrent disease; Rendu Osler Weber disease; slurred speech; thorax radiography; treatment duration; treatment response
Type
journal article