Aseptic abscess syndrome in an adolescent with congenital heart defect and multiorgan inflammation: a case report

We report the case of a 19-year-old male patient with recurrent fever and multiple sterile abscesses involving lymph nodes, subcutaneous tissue, and joints, associated with a congenital cardiac anomaly. The patient presented with persistent febrile episodes and systemic inflammation despite broad-spectrum antibiotic therapy. Imaging revealed disseminated lymphadenopathy and abscesses in cervical, subpectoral, mesenteric, and articular regions. Extensive microbiologic and serologic workup, including bacterial, mycobacterial, and viral testing, remained negative. Histopathology showed necrotising and suppurative lymphadenitis without identifiable pathogens. A diagnosis of aseptic abscess syndrome was established. Treatment with high-dose prednisolone followed by methotrexate led to rapid clinical and laboratory improvement, with normalisation of inflammatory markers and no recurrence of abscesses. This case highlights the importance of recognising aseptic abscess syndrome as a differential diagnosis in patients with culture-negative abscesses and systemic inflammation, to ensure timely immunosuppressive treatment and avoid unnecessary antimicrobial therapy.