Brain Abscesses as a Complication of Brain Hematomas in Infective Endocarditis: A Rare Case Report.

INTRODUCTION: Brain abscesses developing within a nonoperated intracranial hematoma are even rarer. We report brain abscesses developing within 2 hematomas and complicating a methicillin-sensitive Staphylococcus aureus (MSSA) infectious endocarditis (IE). CASE: A previously healthy 26-year-old man without risk factors was diagnosed at hospital day (HD) 2 with a parietal hematoma (24 mm). Angiography did not reveal any aneurysm. He underwent a biological aortic valve replacement at HD4. Valve culture was positive for MSSA. Subsequently, a frontal hematoma appeared, an enlargement of both hematomas, extensive and finger-like edema, and ring enhancement. The puncture of the largest abscess showed red jelly-like material, and the culture was positive for MSSA. Thereafter, the lesions progressively disappeared. CONCLUSION: We emphasize the difficulty of the diagnosis of brain abscess developing within a hematoma, due to the possible absence of clinical changes. However, clinicians should be aware of possible MRI changes. A contrast-enhanced sequence is of paramount importance in the follow-up of brain hematomas in IE patients.