Embolic Brain Abscess in a Patient With Tricuspid Valve Endocarditis and a Patent Foramen Ovale

Abstract

Brain abscess results from local or metastatic septic spread to the brain. Approximately, 15-60% of brain abscesses are considered to be cryptogenetic, being the primary infectious site often undetected. Patent foramen ovale (PFO) has been suggested as a potential source of paradoxical embolism; this was suggested after detecting a higher prevalence of PFO in ischemic stroke of unexplained cause. Brain abscess may develop as a consequence of paradoxical infectious emboli from an extracranial infective source. We present the case of a patient with no history of intravenous drug use and no periodontal disease, which was found to have a brain abscess, tricuspid valve endocarditis and the presence of a PFO with right to left shunting with no other source of infection.

Septic pulmonary and systemic embolism in tricuspid endocarditis

“…The third patient had a brain abscess, and transoesophageal echocardiography detected infective tricuspid endocarditis and PFO. This patient had a complete clinical recovery with brain surgery and intravenous antibiotic therapy 7. Similarly to the reported cases, transoesophageal colour Doppler echocardiography was helpful to detect the PFO, and successful treatment was achieved through PFO closure in our patient.…”

“…Tricuspid valve endocarditis accounts for 5–10% of infective endocarditis 7. In patients with SPE who are suspected of having tricuspid valve endocarditis, echocardiography helps to diagnose valvular infection and to detect complications such as valvular insufficiency or dehiscence, congestive heart failure and paravalvular abscesses.…”