PMC5406206_01
(a) Diffuse varicella-like eruption on the ventral and dorsal trunk and extremities. (b) Close observation of the skin lesions highlights a combination of maculopapular rash, vesicles filled with a serous exudate, and erythematous ulcers. These eruptions were accompanied by tenderness.
10.1177_2050313X17701374-fig1.jpg
PMC5406206_01_10.1177_2050313X17701374-fig1.jpg
fig1-2050313X17701374
A 40-year-old Japanese man with longstanding HIV-1 infection was urgently hospitalized due to high fever, severe malaise, headache, and generalized skin rash (Figure 1(a) and (b)).
(a) Axial T1-weighted image showing a hypointense lesion in the pituitary gland surrounded by a slightly hyperintense rim (arrowhead). (b) Axial T2-weighted image depicting sphenoid sinus mucosa thickening and a hyperintense lesion in the mastoid cell (solid arrow). (c) Sagittal and (d) coronal T1-weighted gadolinium-enhanced images showing a ring-enhancing intrasellar lesion with fluid intensity in its inner part. The pituitary stalk is also enhanced. (e) Diffusion-weighted imaging (DWI) indicating a high-intensity mass in the pituitary fossa. (f) The intrasellar lesion demonstrated restricted diffusion on the apparent diffusion coefficient (ADC) image (open arrow).
10.1177_2050313X17701374-fig2.jpg
PMC5406206_01_10.1177_2050313X17701374-fig2.jpg
fig2-2050313X17701374
T1 hyperintense signal which is normally observed in the posterior pituitary lobe of healthy people (Figure 2(a)), accompanied by sphenoid sinus mucosa thickening (Figure 2(b)). The pituitary lesion had gadolinium ring enhancement, high-intensity signals on diffusion-weighted imaging (DWI), and low-intensity signals on apparent diffusion coefficient (ADC) imaging, characteristic findings for an abscess of the pituitary gland (Figure 2(c)-(f)).
Post-treatment MRIs. (a) Sagittal and (b) coronal enhanced T1-weighted scans showing disappearance of cystic lesion and improvement of pituitary gland and stalk enhancement.
10.1177_2050313X17701374-fig3.jpg
PMC5406206_01_10.1177_2050313X17701374-fig3.jpg
fig3-2050313X17701374
Then, ceftriaxone (2 g/day) was administered for a total of 3 weeks, with improvement of the lesions on follow-up MRI scans (Figure 3(a) and (b)).