PMC9062923_01
(a) Initial contrast-enhanced T1-weighted axial MRI scan demonstrating a heterogeneously enhancing mass in the left temporal lobe with surrounding vasogenic edema. (b) Immediate postoperative contrast enhanced T1-weighted axial MRI.
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F1
Brain magnetic resonance imaging (MRI) with contrast was completed revealing a heterogeneously enhancing mass involving the left temporal lobe with extensive vasogenic edema raising concern for glial neoplasm [Figures 1a and 1b].
Candida immunohistochemical test low power (a), (b) Candida IHC test high power, (c) Grocott's methenamine silver stain showing budding hyphae low power, and (d) GMS high power.
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F2
Candida but negative for neoplasia. Cultures obtained intraoperatively grew C. bantiana [Figures 2a-d].
(a) Six-week follow-up contrast-enhanced axial T1-weighted MRI showing disease progression with worsening edema and mass effect. (b) One-week postoperative redo craniotomy T1-weighted contrast-enhanced T1 axial MRI showing worsening edema with a new cystic collection with mass effect and developing communicating hydrocephalus.
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F3
Six weeks following initial operative management, the patient was readmitted with worsening confusion and repeat imaging demonstrated a recurrent abscess with significant edema and midline shift [Figures 3a and b].
Eight-month follow-up contrast-enhanced T1 axial MRI showing ex vacuo changes with resolution of the disease.
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F4
A 8-month follow- up showed complete resolution of the left temporal lesion [Figure 4].