215 - Uncovering Rare Etiologies: Multifocal Streptococcus intermedius Brain Abscess in an Immunocompromised Adult

Friday, February 20, 2026

5:00 PM - 6:30 PM AST

Presenting Author(s)

TR

Teena Roy, BS

Medical Student
Downstate College of Medicine
New City, New York, United States

Co-Author(s)

OM

Orkhan Mammadov, DO

Physical Medicine and Rehabilitation Physician
Burke Rehabilitation
White Plains, New York, United States
KA

Kunal Aggarwal, MD

Physical Medicine and Rehabilitation Physician
Montefiore Einstein
White Plains, New York, United States

Submitter(s)

TR

Teena Roy, BS

Burke Rehabilitation Hospital
New City, New York, United States

Case Diagnosis: Cryptogenic Brain Abscess

Case Description: A 60-year-old male with a past medical history of alcohol abuse, lymphoma, and right lung abscess resection presented with involuntary jerking of his left arm and fever. Brain magnetic resonance imaging revealed multiple thick-walled peripherally enhancing lesions in the left temporal, left frontal, and right frontoparietal lobes with edema. Hospitalization was complicated by hypomagnesemia. Because of the radiographic findings and seizure risk, the patient underwent needle aspiration and biopsy, confirming the diagnosis of brain abscess. Culture was Streptococcus intermedius positive. In the intensive care unit, the infectious disease team initiated treatment with intravenous ceftriaxone despite no clear source of infection. The patient recovered well with treatment and rehabilitation, making improvements in gait speed, walking distance, and balance score.

Discussions: Multifocal brain abscesses in an adult with a history of alcohol abuse, lymphoma, and lung abscess are unusual and may be associated with disease progression and poorer prognosis. Although the infection source is unclear, it may be related to immunosuppression secondary to alcohol abuse and malignancy. The patient’s hypomagnesemia may indicate underlying malnutrition or chronic illness. Immunosuppression increases risk for hematogenous seeding from occult sources. However, the history, physical, and imaging demonstrate no signs of cardiac or dental infections. The patient’s prior lung abscess resection suggests the source may be related to a residual pulmonary infection or vascular abnormality. Streptococcus intermedius is commonly associated with infection of the respiratory tract. Pulmonary arteriovenous malformations (PAVMs) can cause brain abscesses by facilitating hematogenous spread of pathogens, which bypass the pulmonary capillary filter. Consideration of rare etiologies may help prevent abscess recurrence.

Conclusions: Streptococcus intermedius positive multifocal brain abscesses in an immunocompromised adult are a rare, severe presentation. Rare etiologies like PAVMs should be considered, since source identification guides treatment management.