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Washington University Experience | INFECTION | Bacteria | Abscess | Abscess, Subacute - Chronic | 17A0 Case 17 History
Case 17 History ---- The decedent was a 47 year-old man with a history of schizoaffective disorder and intellectual delay, who presented with cardiac arrest and diffuse cerebral edema after being found down in his Illinois group home on 11/16. CPR was performed with return of spontaneous circulation. He was intubated and taken to an outside hospital, where the only noted neurologic activity was coughing on endotracheal tube suction. CT head imaging showed diffuse cerebral edema with loss of sulci and possible intracranial metastases. A chest/abdomen/pelvis CT did not show any discrete lesions. He was transferred to BJH for further care. At BJH, a CT angiogram of the head and neck showed no intracranial blood flow. MRI showed multifocal supratentorial lesions (radiology favored hemorrhagic metastases) with severe cerebral edema, diffuse global hypoxic ischemic injury, multicompartmental herniation, and subarachnoid hemorrhage. Continuous encephalography showed severe generalized slowing. After discussion with family, the decision was made to transition to comfort care. He passed away on 11/17, one day after presenting. Antemortem laboratory studies did not show growth of infectious organisms on blood cultures. The general autopsy, including a thorough skin examination, did not show any lesions suggestive of a primary malignancy which may have metastasized to the brain but acute bacterial pneumonia was demonstrated, likely the source of the brain organisms.
