PMC6154823_01
Gram-negative filamentous rods
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Fig1
Antibiotics (ceftriaxone, amoxycillin) were continued, and acyclovir was stopped as there were filamentous gram-negative rods in gram staining of the CSF, which was a rare morphology to be identified (Fig. 1).
Non-hemolytic colonies on blood agar
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Fig2
Non-hemolytic colonies were formed on blood agar (Fig. 2) which were lactose-fermenting colonies on MacConkey agar (Fig. 3).
Post-gadolinium T1 image showing subtle ventricular ependymal enhancement (arrow) in occipital horns
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Fig4
There was post-contrast enhancement of leptomeninges and subtle enhancement of ventricular wall and posterior fossa cisternal spaces in post-contrast T1 sequence, and the same findings along with exudates in the ventricles in T2 fluid attenuated inversion recovery (FLAIR) images, which were suggestive of ventriculitis (Figs. 4 and 5).
Post-gadolinium T2 FLAIR showing subtle ventricular ependymal enhancement and exudates (arrow) in occipital horns
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Fig5
There was post-contrast enhancement of leptomeninges and subtle enhancement of ventricular wall and posterior fossa cisternal spaces in post-contrast T1 sequence, and the same findings along with exudates in the ventricles in T2 fluid attenuated inversion recovery (FLAIR) images, which were suggestive of ventriculitis (Figs. 4 and 5).
CT cisternography showing no contrast leak into paranasal sinuses
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Fig6
There was no CSF leak into the paranasal sinuses or nasal cavity (Fig. 6).