**FIRST, A PEARL FROM YESTERDAY’S AM REPORT: A clue to diagnosing lymphoma is new alcohol intolerance (alcohol-related pain at lymph node sites)! A one-page case is attached.
Intern report PEARLS: strep anginosus, brain abscesses
**PEARL: when you uncover strep anginosus (a strep viridans spp), look for abscesses!! Treatment is abscess drainage and prolonged abx.
Approach to brain abscesses:
- Causes: 1. direct spread (from oral cavity, sinuses), 2. hematogenous seeding (eg from endocarditis or bacteremia), or 3. trauma (including recent surgery)
- Subacute/chronic otitis media and mastoiditis à inferior temporal lobe, cerebellum
- Frontal/ethmoid sinuses, dental infections à frontal lobes
- Hematogenous: often multiple abscesses
- Micro: Usually will give a clue to the primary source of infection. Can think of it as monomicrobial or polymicrobial, depending on the cause.
- Think about immune status: immunocompromised hosts (HIV/AIDs, neutropenic, on immunosuppression) are also at risk of TB, fungal, parasitic infections
- Dx: suggestive MRI/CT findings, CT-guided aspiration or surgery.
- **If focal s/sx, or imaging c/f mass effect, LP is contraindicated!
- Check out the attached NEJM review article on brain abscesses for more!