AI Summary
A 49-year-old man presented with fever, headache, vomiting, and altered sensorium. Brain MRI showed a lesion and chest CT showed pneumonitis. He was initially treated for tuberculosis and toxoplasmosis but was later diagnosed with AIDS and syphilis. Biopsy confirmed amoebic meningoencephalitis. The patient died after 19 days. These imaging findings may indicate amoebic meningoencephalitis in the right clinical context.
A 49-year-old man presented with low-grade fever for 4 weeks, headache and vomiting for 2 weeks, and altered sensorium for 1 day. He was drowsy, was obeying intermittently, and had terminal neck stiffness, but no localizing/lateralizing neurologic signs. Brain MRI showed right occipital lobe lesion (Figure 1), and CT chest showed features of pneumonitis (Figure 2, C and D). Differential diagnosis included amoebic encephalitis, fungal granuloma, toxoplasmosis, septic emboli, hemorrhagic infarcts, abscesses, and neoplasms.1 He was initially managed empirically with antituberculosis therapy and antitoxoplasma medication (sulfadiazine, pyrimethamine). HIV-1 and Treponema pallidum hemagglutination serologies showed positive results. CD4 count was 15 cells/μL. After he was detected to experience AIDS and syphilis, penicillin was added. Biopsy of the lesion confirmed granulomatous amoebic meningoencephalitis (GAM) (Figure 2, A and B). Fluconazole and cotrimoxazole were initiated. He died after 19 days of hospitalization. In the appropriate clinical settings, these imaging findings may raise the suspicion of GAM.