PMC5340051_01
Magnetic resonance images brain and orbit. (a) Sagittal and (b) axial scans showing multiple sub-centimeter discrete ring enhancing lesions scattered in bilateral cerebral hemispheres; (c), T2W axial image after six weeks of initial MRI showing enlarged cerebral lesion with accompanying significant edema and mass effect; (d), with post contrast irregular enhancement; (e), axial orbit sections show the deformed globes with associated inflammatory changes in retro-orbital fat as patchy T2 hyper intensity; (f), T1W image shows the evidence of hemorrhage within the left globe.
JOVR-12-113-g001.jpg
PMC5340051_01_JOVR-12-113-g001.jpg
F1
Magnetic resonance imaging (MRI) of the brain [Figure 1a and b] showed multiple cystic-enhancing lesions over both cerebral hemispheres, suggestive of tuberculomas or neurocysticercosis. Due to the progressive worsening of patients' systemic status and severe cachexia, a repeat MRI of the brain was done, and revealed a large right parieto-occipital mass lesion [Figure 1c and d]. The orbital region showed bilateral globe deformities, intraocular hemorrhages, and extraocular soft-tissue inflammation [Figure 1e and f].
Clinical photographs of the patient after Ahmed glaucoma valve implantation showing severe conjunctival chemosis and mechanical complete ptosis of both eyes.
JOVR-12-113-g002.jpg
PMC5340051_01_JOVR-12-113-g002.jpg
F2
Postoperatively, the left eye was stony hard with severe conjunctival chemosis and a shallow anterior chamber [Figure 2].
(a) Scanner view of necrotic area (H and E x40) and high power view (b) (H and E x100) of the same area showing granulomatous response with giant cells; (c), high power view of the same area showing granulomatous response with multinucleate giant cells (H and E x400); (d), Gram stain of the same area showing gram positive filamentous hyphae of Nocardia (Gram x400). H and E, hematoxylin and eosin staining.
JOVR-12-113-g003.jpg
PMC5340051_01_JOVR-12-113-g003.jpg
F3
A multiloculated intracerebral abscess was drained, and a brain biopsy was performed, revealing the presence of the Nocardia organism along with granulomatous reactions [Figure 3a-d].