A Woman with a Lung Infiltrate and Brain Abscesses: Case Discussion from the University of Louisville Hospital

Dr. Veronica Corcino (Infectious Diseases fellow): A 61-year-old female with no history of systemic disease presented to an outlying hospital with a headache, seizure-like episode and progressive productive cough for one month who presented to the emergency room of an outlying hospital where two brain lesions were detected on a computerized tomography (CT) scan. She was transferred to this university hospital the same day. She initially complained of dry cough that progressed to be productive a month prior to admission, however she had refused to seek medical care. She lives in Grand Rapids, Michigan and decided to visit her daughter in rural Kentucky in the winter. Her family stated she had chills, fevers, generalized weakness and a poor appetite the day prior to admission. Eventually, her headache progressed and she developed a seizure-like episode with loss of consciousness, which prompted going to the hospital. On presentation, her temperature was 100.9° F, blood pressure 145/80 mm Hg, pulse 110 beats/minute, and respiratory rate 23 breaths/minute. Her oxygen saturation was 95% on ambient air. Admission laboratory tests, including blood cultures, were collected. (Table 1) A chest radiograph (Figure 1) and head CT were also obtained (Figure 2). Diagnostic Approach