Concurrent bacterial liver abscess and mild encephalitis/encephalopathy with reversible splenial lesion in a patient with poorly controlled type 2 diabetes

• Published in: Diabetology international Vol. 14; no. 3; pp. 312 - 317
• Main Authors: Sekikawa, Naohiro, Hirai, Hiroyuki, Sugimoto, Kazuhiro, Kusano, Yoshiro
• Format: Journal Article
• Language: English
• Published: Singapore Springer Nature Singapore 01.07.2023; Springer Nature B.V
• Subjects: Abscesses; Antibiotics; Bacteria; Case Report; Ceftriaxone; Cerebrospinal fluid; Computed tomography; Consciousness; Corpus callosum; Diabetes; Diabetes mellitus (non-insulin dependent); Diffusion coefficient; Encephalitis; Encephalopathy; Endocrinology; Headache; Hemoglobin; Lesions; Liver; Magnetic resonance imaging; Medicine; Medicine & Public Health; Metabolic Diseases; Metronidazole; Vomiting; Splenium of corpus callosum (SCC); Mild encephalitis/encephalopathy with reversible splenial lesion (MERS); Bacterial liver abscess; Type 2 diabetes (T2D)
• ISSN: 2190-1678; 2190-1686
• DOI: 10.1007/s13340-023-00635-z

A 34-year-old man with poorly controlled type 2 diabetes was admitted to our hospital because of fever, headache, vomiting, and impaired consciousness. His hemoglobin A1c level was as high as 11.0%. Abdominal computed tomography revealed a bacterial liver abscess, while head magnetic resonance imaging simultaneously showed a high-signal lesion on diffusion-weighted imaging and a low-signal lesion on the apparent diffusion coefficient map of the splenium of the corpus callosum. No significant findings were detected in the cerebrospinal fluid. The latter findings led to a diagnosis of mild encephalitis/encephalopathy with reversible splenial lesions. His impaired consciousness resolved on Day 5 after treatment with ceftriaxone and metronidazole infusion and intensive insulin therapy; magnetic resonance imaging on Day 20 showed that the lesion in the splenium of the corpus callosum had disappeared. We propose that when a person with poorly controlled diabetes develops a bacterial infection and presents with impaired consciousness and headache, clinicians should consider the complications of mild encephalitis/encephalopathy with reversible splenial lesion.