PMC2957978_01
Hematoxylin and eosin-stained sections from patient 1 (panels A, B) and patient 2 (panels C, D). Note the predominantly lymphohistocytic infiltrate forming large granulomas (A, original magnification 100x); well-formed giant cells (B, arrow, original magnification 200x); lymphohistiocytic infiltrates distorting brain parenchyma and forming vague granulomas (C, original magnification 40x); and the dense astrogliosis at the interface between granulomatous inflammation and surrounding brain parenchyma (D, asterisk, original magnification 100x).
02-0576-F1.jpg
PMC2957978_02_02-0576-F1.jpg
F1
Final histopathologic examination showed numerous granulomas with multinucleated giant cells but no organisms (Figure 1).
PMC2957978_02
Hematoxylin and eosin-stained sections from patient 1 (panels A, B) and patient 2 (panels C, D). Note the predominantly lymphohistocytic infiltrate forming large granulomas (A, original magnification 100x); well-formed giant cells (B, arrow, original magnification 200x); lymphohistiocytic infiltrates distorting brain parenchyma and forming vague granulomas (C, original magnification 40x); and the dense astrogliosis at the interface between granulomatous inflammation and surrounding brain parenchyma (D, asterisk, original magnification 100x).
02-0576-F1.jpg
PMC2957978_02_02-0576-F1.jpg
F1
Final histopathologic examination showed numerous granulomas with multinucleated giant cells but no organisms (Figure 1).
Axial MRI (magnetic resonance imaging) from patient 2 obtained when first seen in Peru (April 21, 2001), before surgical biopsy in the United States (September 21, 2001), and 7 months after start of treatment (June 7, 2002). The top images are postgadolinium-enhanced, T1-weighted images, which demonstrate resolution of one of the irregular areas of enhancement over time. The bottom images are T2-weighted images (image from April 21 is from a fluid attenuated inversion recovery [FLAIR] sequence), which demonstrate the extensive brain edema associated with these lesions. The right bottom image shows resolution of the brain edema but persistent brain atrophy.
02-0576-F2.jpg
PMC2957978_02_02-0576-F2.jpg
F2
A magnetic resonance imaging (MRI) scan performed in April 2001 showed several large, irregular enhancing mass lesions involving the left occipital and parietal lobes (Figure 2). Repeat MRI showed several irregular areas of enhancement in the left parietooccipital area associated with marked brain edema, left-to-right shift, and mass effect (Figure 2). Follow-up imaging 7 months later demonstrated resolution of the enhancing areas and edema, with residual areas of brain atrophy (Figure 2).