case_images: PMC4665129_01
case_images: PMC4665129_02
case_images: Preoperative axial images. T1-weighted image after gadolinium administration (a), demonstrating multiloculated ring-enhancement. Diffusion- weighted image demonstrates a very small amount of increased signal (b), but a decreased apparent diffusion coefficient value is not obvious (c). Findings are consistent with malignant neoplasm, either primary or metastatic, but also with abscess
case_images: SNI-6-174-g001.jpg
case_images: PMC4665129_02_SNI-6-174-g001.jpg
case_images: F1
case_images: While closely associated with the convexity dura and the tentorium, the masses appeared to be intra-axial, and were interpreted as most consistent with malignant glioma or metastatic lesion [Figure 1].
case_images: Postoperative axial T1-weighted image after gadolinium administration, demonstrating resection of the lesions with postoperative changes and no evidence of residual enhancement
case_images: SNI-6-174-g002.jpg
case_images: PMC4665129_02_SNI-6-174-g002.jpg
case_images: F2
case_images: The abscess was resected [Figure 2] and the patient was started on intravenous lipid complex amphotericin B and flucytosine, which he received for approximately 3 weeks.
case_images: Numerous giant cells are present in the granulomatous inflammation (a), many of which contain intracytoplasmic fungal organisms (b). A CD163 stain shows abundant macrophages (c)
case_images: SNI-6-174-g003.jpg
case_images: PMC4665129_02_SNI-6-174-g003.jpg
case_images: F3
case_images: A CD163 stain demonstrated abundant macrophages, and also highlighted the larger, multinucleated histiocytic giant cells [Figure 3].
case_images: The fungal organisms are positive with both periodic acid-Schiff (a) and Gomori's methenamine silver stains (b)
case_images: SNI-6-174-g004.jpg
case_images: PMC4665129_02_SNI-6-174-g004.jpg
case_images: F4
case_images: The fungal organisms were positive for both periodic acid-Schiff and Gomori's methenamine silver [Figure 4] stains.
case_images: There is an abundance of both CD4 helper T cells (a) and CD8 cytotoxic T cells (b)
case_images: SNI-6-174-g005.jpg
case_images: PMC4665129_02_SNI-6-174-g005.jpg
case_images: F5
case_images: There was an abundance of T cells, with a slight predominance of the CD4 helper/inducer subset as compared to the CD8 cytotoxic/suppressor subset [Figure 5].
case_images: The CD56 (a) and CD57 (b) stains show that rare natural killer cells are present
case_images: SNI-6-174-g006.jpg
case_images: PMC4665129_02_SNI-6-174-g006.jpg
case_images: F6
case_images: Natural killer cells were rarely present [Figure 6].
case_images: Axial T1-weighted image after gadolinium administration showing complete resolution of lesions with chronic encephalomalacia at 1 year postsurgery and after completing antifungal treatment
case_images: SNI-6-174-g007.jpg
case_images: PMC4665129_02_SNI-6-174-g007.jpg
case_images: F7
case_images: His MRI at this time showed small lobulated areas of enhancement that were interpreted as postsurgical change and not a recurrence of the abscess [Figure 7].