Concurrent bacterial liver abscess and mild encephalitis/encephalopathy with reversible splenial lesion in a patient with poorly controlled type 2 diabetes

A 34-year-old man with poorly controlled type 2 diabetes was admitted to our hospital because of fever, headache, vomiting, and impaired consciousness. His hemoglobin A1c level was as high as 11.0%. Abdominal computed tomography revealed a bacterial liver abscess, while head magnetic resonance imagi...

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Bibliographic Details
Published in:Diabetology international 2023-07, Vol.14 (3), p.312-317
Main Authors: Sekikawa, Naohiro, Hirai, Hiroyuki, Sugimoto, Kazuhiro, Kusano, Yoshiro
Format: Article
Language:English
Subjects:
Abscesses
Bacteria
Case Report
Ceftriaxone
Cerebrospinal fluid
Computed tomography
Consciousness
Corpus callosum
Diabetes
Diabetes mellitus (non-insulin dependent)
Diffusion coefficient
Encephalitis
Encephalopathy
Endocrinology
Headache
Hemoglobin
Lesions
Liver
Magnetic resonance imaging
Medicine
Medicine & Public Health
Metabolic Diseases
Metronidazole
Vomiting
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Summary:A 34-year-old man with poorly controlled type 2 diabetes was admitted to our hospital because of fever, headache, vomiting, and impaired consciousness. His hemoglobin A1c level was as high as 11.0%. Abdominal computed tomography revealed a bacterial liver abscess, while head magnetic resonance imaging simultaneously showed a high-signal lesion on diffusion-weighted imaging and a low-signal lesion on the apparent diffusion coefficient map of the splenium of the corpus callosum. No significant findings were detected in the cerebrospinal fluid. The latter findings led to a diagnosis of mild encephalitis/encephalopathy with reversible splenial lesions. His impaired consciousness resolved on Day 5 after treatment with ceftriaxone and metronidazole infusion and intensive insulin therapy; magnetic resonance imaging on Day 20 showed that the lesion in the splenium of the corpus callosum had disappeared. We propose that when a person with poorly controlled diabetes develops a bacterial infection and presents with impaired consciousness and headache, clinicians should consider the complications of mild encephalitis/encephalopathy with reversible splenial lesion.
ISSN:2190-1678
2190-1686
DOI:10.1007/s13340-023-00635-z