Infectious Diseases Case of the Month
Brain Lesion

A 25 y.o. hispanic male was admitted to the hospital for a seizure.

Previously in good health he had been born in Mexico and lived there until eight months prior to admission when he and his wife emigrated to Lake Chelan, WA (map) where he was employed as a laborer in the fruit orchards. He was married and his wife had immigrated with him.

A couple of weeks prior to admission he had fallen from a ladder while picking fruit sustaining an injury to his knee necessitating orthopedic evaluation and knee immobilization.

On the date of hospital admission he had developed a left frontal headache and subsequently experienced the onset of involuntary shaking of his left upper and lower extremities. He did not experience loss of consciousness. A CT scan showed a focal area of low density in the right parietal region. A subsequent MRI scan showed a 1-2 cm cystic structure with central opacity with surrounding edema similar to the MRI scan featured at left.

The patient was afebrile with otherwise normal vital signs. Examination was unremarkable. He denied sexual promiscuity, IVDU, or other HIV risk factors and had not had recent prolonged respiratory symptoms. He was begun on dilantin and dexamethasone, and neurosurgery consultation was obtained. He underwent neurosurgical resection of the cystic abnormality. Prior to surgery these labs were obtained: WBC 13.7 (with normal differential), Hgb 13.3(L), Na 139, Ca 10.4.

An infectious diseases consultation was requested after initial review of the pathological specimen.

What was the most likely cause of this patient's cystic brain abnormality?
Submit your answer below.
Your First and Last Name

What was the likely cause of the patient's febrile illness?

Send Your Answer


Answer and commentary will follow your submission.