Previously undiagnosed pulmonary arteriovenous malformation in hereditary hemorrhagic telangiectasia presenting as a brain abscess: a case report

Abstract

Abstract Introduction Pulmonary arteriovenous malformations (PAVMs) are abnormal vascular connections that predispose to paradoxical embolism and brain abscess formation. They often remain undetected until severe complications occur, posing significant diagnostic challenges. Case presentation We report the case of a young woman who presented with new onset focal seizures. Brain MRI with contrast revealed two ring enhancing lesions, suggestive of brain abscesses. The larger lesion was drained surgically, whereas the smaller one was conservatively treated with antibiotics. During her recovery, a sudden decline in her respiratory function was noted, which prompted additional investigations. CT pulmonary angiography showed pulmonary arteriovenous malformation; subsequently, she underwent a successful angioembolization. Based on the clinical presentation of this patient, the possibility of previously undiagnosed hereditary hemorrhagic telangiectasia (HHT) was considered. Conclusion This case underscores the significance of evaluating PAVMs as a potential source of brain abscesses, particularly in young patients without apparent risk factors. Early recognition and management of PAVMs, including angioembolization, are essential to prevent recurrence and better outcomes.