Brain abscess and Osler-Weber-Rendu syndrome: Do not forget to look for pulmonary arteriovenous malformations

• Published in: La revue de medecine interne 2020-11, Vol.41 (11), p.776-779
• Main Authors: Aubignat, M, Salomon, A, Chivot, C, Delanghe, F, Lecat, B, Jeanjean, P, Peltier, J
• Format: Article
• Language: fre
• Subjects: Aged; Anti-Bacterial Agents - therapeutic use; Arteriovenous Fistula - diagnosis; Arteriovenous Fistula - etiology; Arteriovenous Fistula - therapy; Arteriovenous Malformations - diagnosis; Arteriovenous Malformations - etiology; Arteriovenous Malformations - therapy; Brain Abscess - diagnosis; Brain Abscess - etiology; Brain Abscess - therapy; Embolization, Therapeutic; Female; Humans; Pulmonary Artery - abnormalities; Pulmonary Veins - abnormalities; Telangiectasia, Hereditary Hemorrhagic - complications; Telangiectasia, Hereditary Hemorrhagic - diagnosis; Telangiectasia, Hereditary Hemorrhagic - therapy
• ISSN: 1768-3122
• DOI: 10.1016/j.revmed.2020.06.009

Osler-Rendu-Weber syndrome or hereditary hemorrhagic telangiectasia affects between 1/5000 and 1/8000 people. It is characterized by presence of recurrent epistaxis, mucocutaneous telangiectasia and visceral arteriovenous malformations. It is a genetic disease with autosomal dominant transmission inducing an endothelial cells hyper-proliferation. A 68-year-old women with Osler-Rendu-Weber syndrome was referred for management of general impairment with confusional syndrome and hyperthermia. Various examinations have allowed us to conclude at diagnosis of brain abscess with ventriculitis probably favored by right-left shunt secondary to pulmonary arteriovenous malformations. Evolution was favorable after antibiotic treatment and endovascular embolization. In case of brain abscess without obvious promoting factor, don't forget to looking for a right-left shunt providing septic or aseptic emboli. Furthermore, diagnosis of Rendu-Osler-Weber syndrome should be considered presence of telangiectasias and/or epistaxis.