Multiple Brain Abscesses Associated With Severe Bronchiectasis and Respiratory Infection: A Case Report

Brain abscess is a rare but life-threatening intracranial infection most commonly resulting from hematogenous dissemination or contiguous spread. Pulmonary infections, including bronchiectasis, may represent a potential source of systemic infection. We report the case of a 50-year-old woman with type 2 diabetes mellitus admitted for acute hypoxemic respiratory failure secondary to severe bronchiectasis-associated infection complicated by acute respiratory distress syndrome (ARDS). Respiratory samples identified Streptococcus pneumoniae and Influenza A virus. Blood cultures remained negative. The patient initially improved under empirical antibiotic therapy but subsequently developed neurological deterioration on hospital day 5, characterized by seizures and nystagmus. Brain magnetic resonance imaging (MRI) revealed multiple bilateral cerebral abscesses with ring enhancement and diffusion restriction consistent with pyogenic abscesses. Transthoracic echocardiography showed no evidence of infective endocarditis, although transesophageal echocardiography was not performed. Despite escalation of antimicrobial therapy and intensive care management, the patient developed refractory septic shock and multiorgan failure, resulting in death.