Bacterial Brain Abscesses in a Patient With Transposition of the Great Arteries and Interventricular Communication.

Brain abscesses are localized infections in the brain's parenchyma, characterized by inflammation, pus formation, and the development of a surrounding capsule. These lesions typically occur due to underlying factors such as immunosuppression, ear and sinus infections, and contamination during neurosurgery. While brain abscesses are a life-threatening complication of cyanotic heart defects, they are rarely reported, with only sporadic cases previously documented. This article presents the case of an eight-year-old male patient with an uncorrected transposition of the great arteries, who was evaluated for symptoms including headache, fever, and neurological focalization. Diagnostic imaging revealed three lesions consistent with brain abscesses. Furthermore, the causal agents were identified as Streptococcus intermedius and Fusobacterium spp., representing oral microorganisms. Additionally, the patient exhibited poor oral hygiene and dental caries in multiple teeth. This article discusses and integrates the possible pathophysiological mechanisms that allowed a localized dental infection to spread hematogenously and cause brain abscesses in this patient. Prompt management of the infectious source is crucial to prevent a poor prognosis associated with brain abscesses. Therefore, this case emphasizes the importance of regular dental assessments and thromboprophylaxis for patients with underlying cardiomyopathies that cause right-to-left shunting to prevent potential complications.

Primary Varicella or Herpes Zoster? An Educational Case Report From the Primary Care Clinic.

Varicella-zoster virus is a pathogenic virus that can present itself as a primary infection or secondary infection, also known as herpes zoster. Recently, there has been a re-emergence of this vaccine-preventable disease due to gaps in vaccination. Primary varicella in immunocompetent adults is highly uncommon, and it could result in severe complications within this population. Given this delicate scenario, family physicians should be well trained to recognize the characteristic cutaneous lesions of varicella and dictate adequate management for these patients to obtain the best possible outcome and prevent life-threatening complications. We present the case of a 43-year-old immunocompetent woman with the onset of a generalized pruritic dermatosis characterized primarily by the presence of macules, vesicles, and crusts. The patients' lesions were compatible with primary varicella, and serological studies confirmed the diagnosis. Given the absence of acute complications in this individual, supportive treatment and close follow-up were the therapeutic modalities. This article focuses on the educational discussion of the primary differential diagnosis, evaluation for possible complications, and management of this uncommon clinical scenario. We also reinforce the importance of immunization in preventing re-emergent diseases as a critical element within primary care management.

An Uncommon Presentation of Pyogenic Granuloma.

Benign vascular neoplasms are common clinical problems encountered in the practice of primary care. Pyogenic granulomas are one of the most common benign vascular lesions in young adults. Although the physiopathological mechanism for the development of this condition is still not well understood, it has been commonly associated with several triggers such as treatment with retinoids, biological agents, invasive cutaneous therapies and trauma. The development of pyogenic granulomas on sites of vascular malformations like port wine stains has been described in the literature to occur rarely. Most of these types of cases have been studied to occur in the setting of pregnancy and after cryotherapy or pulsated laser therapy. The aim of this article is to present the case of a 21-year-old man with a recent appearance of a pyogenic granuloma within an underlying port wine stain in the posterior cervical region without any history of triggers or risk factors. Excision of the vascular lesion was done, and histopathological report confirmed the diagnosis. The objective of this manuscript is to discuss the possible mechanisms involved in the development of this uncommon presentation and to summarize the current literature related to this clinical scenario.