Contributed by Sorya Belaz, MD1, Dan Chiforeanu, MD2, Jean-Maxime Devaux, Medical Student1, Pierre Tattevin, MD, PhD3, Florence Robert-Gangneux MD, PhD1 , and Jean-Pierre Gangneux MD, PhD1
Departments of 1Parasitology and Mycology, 2Anatomopathology and 3Infectious diseases Centre Hospitalier Régional Universitaire, Rennes, France
A 37 year old female from Brazil presented with paresthesia and cramping in the left calf. She also reported transient loss of strength in the left arm. Neurological examination revealed paresthesia on the entire left side of her body. No clinical abnormality was noted on physical examination, including breast and lymph node examination. During hospitalization, she presented sensorimotor seizure of the left arm and leg. Cerebral MRI showed a rolandic right lesion of postcentral gyrus with FLAIR hypersignal (Figure 1), heterogeneous enhancement and edema around the lesion (Figures 1 and 2). Laboratory tests, including blood cell count and CSF puncture, did not find any abnormality. Cerebral biopsy for diagnosis was performed.
The cerebral parenchyma showed several inflammatory lesions, with an epithelioid granuloma and gigantocellular cells surrounding a foreign body. After PAS staining (Figure 3) these foreign bodies appeared unstained; they were Ziehl-Neelsen positive (Figure 4). What is your diagnosis?