Presentation
Fever with seizures.
Patient Data
Ring and nodular enhancing lesions in cerebellar vermis, bilateral cerebellar hemispheres, right basal ganglia, and bilateral cerebral hemispheres. These lesions show areas of diffusion restriction suggestive of abscesses. Some of these are hypointense on T2W images. Foci of blooming are seen in most of these lesions. Mild to moderate perilesional edema is seen around these lesions.
No significant mass effect is on the ventricles. No obvious midline shift is seen in the present scan.
Areas of diffusion restriction are seen in the left frontoparietal, temporal lobes, and left basal ganglia, likely vasculitis-related infarcts.
Late subacute infarct/ischemia is seen in the right frontal lobe with possible cortical laminar necrosis.
Case Discussion
On the basis of above imaging findings, first possibility of a fungal infection was raised (in view of foci of blooming). Other possibility of tuberculosis was kept due to the T2 hypointense centers of the lesions.
On laboratory investigations, serum galactomannan was positive (1.22 pg/ml), suggestive of invasive aspergillosis.
It is important to note that false-positive serum galactomannan is encountered in numerous settings, including 1:
concurrent fungal infections elsewhere
enteral nutrition and various foods
intravenous administration b-lactam antibiotics
intravenous administration of solutions containing sodium gluconate or some blood product conditioning fluids
multiple myeloma
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