case_images: PMC4061578_01
case_images: T1 with contrast, FLAIR, and DWI MRI shortly after presentation
case_images: SNI-5-80-g001.jpg
case_images: PMC4061578_01_SNI-5-80-g001.jpg
case_images: F1
case_images: MRI performed shortly after presentation [Figure 1] demonstrates a 2 x 4 cm heterogeneous intracranial mass lesion involving the left motor cortex and extending into the ipsilateral parietal lobe.
case_images: Magnetic Resonance Spectroscopy
case_images: SNI-5-80-g002.jpg
case_images: PMC4061578_01_SNI-5-80-g002.jpg
case_images: F2
case_images: There appeared to be peaks between 3.6 and 3.8 ppm over the enhancing area that were not present in the contralateral normal brain [Figure 2].
case_images: T2 FLAIR MRI one month after presentation
case_images: SNI-5-80-g003.jpg
case_images: PMC4061578_01_SNI-5-80-g003.jpg
case_images: F3
case_images: Repeat MRI at one month demonstrated worsening edema consistent with worsening of the pathologic process [Figure 3].
case_images: T1 with contrast MRI on postoperative day one
case_images: SNI-5-80-g004.jpg
case_images: PMC4061578_01_SNI-5-80-g004.jpg
case_images: F4
case_images: The MRI performed on postoperative day one showed some residual enhancement along the splenium of the corpus callosum [Figure 4].
case_images: T2 FLAIR MRI one year postoperative
case_images: SNI-5-80-g005.jpg
case_images: PMC4061578_01_SNI-5-80-g005.jpg
case_images: F5
case_images: At last follow-up 1 year postoperation, cerebritis had resolved on MRI [Figure 5] and her neurologic status was normal.
case_images: Hematoxylin and eosin stain at x200 magnification
case_images: SNI-5-80-g006.jpg
case_images: PMC4061578_01_SNI-5-80-g006.jpg
case_images: F6
case_images: Hematoxylin and eosin staining showed chronic granulomatous inflammation with caseating necrosis, multinucleated giant cells, and epithelioid histiocytic cells [Figure 6] Periodic acid-Schiff staining showed broad based budding yeast, compatible with Blastomycosis [Figure 7].
case_images: Silver stain at x400 magnification
case_images: SNI-5-80-g007.jpg
case_images: PMC4061578_01_SNI-5-80-g007.jpg
case_images: F7
case_images: Hematoxylin and eosin staining showed chronic granulomatous inflammation with caseating necrosis, multinucleated giant cells, and epithelioid histiocytic cells [Figure 6] Periodic acid-Schiff staining showed broad based budding yeast, compatible with Blastomycosis [Figure 7].