When Do Ring-Enhancing Brain Lesions Need to Be Biopsied, and Should They Be Treated Empirically First?

  • Nadia Khosrodad Department of Internal Medicine, St. Joseph Mercy Oakland Hospital, Pontiac, MI, USA
  • Justin Khine Clinical Teaching Fellow, Ross University, Miramar, FL, USA
  • Jeffrey Maclean Department of Radiology, St. Joseph Mercy Oakland Hospital, Pontiac, MI, USA
  • Fnu Abhishek Department of Neurology, St. Joseph Mercy Oakland Hospital, Pontiac, MI, USA

Keywords

Neuroimaging, abscess, immunocompromised, toxoplasmosis, PCNSL, idiopathic CD4 leukocytopenia

Abstract

Other than acute cerebrovascular accidents, multiple ring-enhancing lesions are among the most common lesions encountered in neuroimaging. We herein describe the case of a 63-year-old diabetic man presenting with altered mental status, hyperglycaemia and community-acquired pneumonia who was found to have two ring-enhancing lesions involving the left frontal lobe and left basal ganglia. The lesions were biopsied to reveal positive fungal cultures and toxoplasma cysts. RPR titres returned reactive for non-treponemal antibodies and a suppressed CD4 count was found without evidence of HIV infection.

References

  • Mahato PS, Dabhi AS, Thorat PB. Clinical and investigative profile of ring-enhancing lesions on neuroimaging. Indian Journal of Clinical Practice 2012;22:512–518.

  • Garg R, Sinha M. Multiple ring-enhancing lesions of the brain. J Postgrad Med 2010;56:307.

  • Chen S, Pu J-L, Yu J, Zhang J-M. Multiple Aspergillus cerebellar abscesses in a middle-aged female: case report and literature review. Int J Med Sci 2011;8:635–639.

  • Sessa A, Meroni M, Battini G, et al. Nosocomial outbreak of Aspergillus fumigatus infection among patients in a renal unit? Nephrol Dial Transpl 1996;11:1322–1324.

  • Gutiérrez-Cuadra M, Ballesteros-Sanz MA, Vallejo A, Miñambres E, Fariñas Alvarez C, García-Palomo JD, García-Palomo JD, et al. Brain abscess in a tertiary medical center: epidemiology and prognostic factors related to mortality. Rev Española Quimioter 2009;22:201–206.
  • Published: 2019-04-10

    Issue: Vol 6 No 4 (view)

    Section: Articles

    How to cite:
    Khosrodad, N., Khine, J., Maclean, J., & Abhishek, F. (2019). When Do Ring-Enhancing Brain Lesions Need to Be Biopsied, and Should They Be Treated Empirically First?. European Journal of Case Reports in Internal Medicine, 6(4). https://doi.org/https://doi.org/10.12890/2019_001068