Background: Pyogenic brain abscesses are focal intracranial infections characterized by purulent collections in the brain parenchyma. Autopsy is vital for confirming diagnoses, especially in rapidly progressive or atypical cases.

Case presentation: We report the case of a previously healthy man in his twenties who presented with headaches, altered consciousness, and visual impairments. Notably, he did not have fever. A brain CT scan revealed a left basifrontal heterogeneous mass causing a midline shift. However, a definitive diagnosis was not established before the patient’s rapid deterioration and subsequent death. Post-mortem examination revealed a purulent collection in the left frontal lobe and meninges, confirming a Pyogenic brain abscess. Microbiological analysis of the pus identified Streptococcus constellatus. Histological examination showed reactive gliosis in the cerebral parenchyma, excluding malignancy.

Conclusion: This case underscores the importance of considering pyogenic brain abscesses in the differential diagnosis, even in atypical presentations. Furthermore, it emphasizes the crucial role of autopsy in establishing a definitive diagnosis in cases of sudden and unexpected death, allowing for accurate cause-of-death determination through microbiological and histological analysis. This case also highlights the need for increased awareness among clinicians regarding the varied presentations of pyogenic brain abscesses to improve diagnostic accuracy and patient outcomes.

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