PMC8267539_01
Skull x-ray showing osteolytic lesion.
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Skull x-ray (Fig. 1) revealed osteolytic lesion in the left frontal bone with sclerotic margins and increased thickness of the skull.
MRI- Sagittal plane.. MRI shows a well defined rounded extra-axial lesion seen in the left frontal area measuring 32 x 26 x 18.5 mm in AP transverse and craniocaudal dimension, it is connected to a superficial subcutaneous scalp soft tissue swelling showing the same characteristics and measuring about 37 x 30 mm in transverse and craniocaudal dimension.
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MRI (Fig. 2, Fig. 3) showed well-defined rounded extra-axial lesion seen in the left frontal area measuring 32 x 26 x 18.5 mm, connected to a superficial subcutaneous scalp soft tissue measuring about 37 x 30 mm.
Cut section of skull showing irregular bosselated grey-brown destructive lesion with purulent foci.
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Intraoperatively, with opening over the previous scar, a semi-rounded mass, firm to hard in consistency, with surrounding cheesy material lesion (Fig. 4), invading the bone, with dural infiltration but no intra-axial extension.
Gram stain.. Multiple colonies of radiating filamentous organisms (horizontal white arrow) with peripheral rim of splendor hoeppli phenomenon (vertical white arrow) surrounded by dense neutrophilic infiltrate (black arrow).
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Periodic acid-Schiff (PAS) and Period acid stain with diastase (PASD), surrounded by well-defined granulomas and micro-abscesses (Fig. 5). Patient had an uneventful post-operative period and was discharged on the 4th post-operative day.