PMC5180434_01
Anteroposterior X-ray of the thorax does not show evidence of any pathology, no parahiliar consolidations, and no other variations (a). Anteroposterior abdominal radiography where no abnormal changes are seen (b)
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F1
Electroencephalogram demonstrates the presence of cyclic and inverted waves. These waves are seen in the occipital region and where a marked, diffuse slowing occurs (a)
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F2
Further, an electroencephalogram (EEG) [Figure 2] was performed.
Note the magnetic resonance imaging (MRI) of the skull in the axial T2 sequence where data loss of corticosubcortical volume are observed diffusely (a). MRI in T2 sequence where hyperintensity data are identified at the level of caudate nucleus heads and putamen bilaterally with tendency to symmetry (b). MRI in T2 fluid attenuated inversion recovery (FLAIR) sequence where hyperintensity data are identified at the level of caudate nucleus heads and putamen bilaterally with tendency to symmetry (c). MRI in sequence diffusion (diffusion weighted imaging) where diffusion restriction is identified at the level of caudate nucleus heads, splenius of the corpus callosum (d). MRI in sequence diffusion (diffusion weighted imaging) where diffusion restriction is identified at the level of right temporoparietal cortical region predominantly right cortical region and in both putamen which tends to symmetry (e)
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F3
It was, however, also observed on the left side, with a diffuse loss of volume of brain parenchyma, as well as evidence of the restriction of the diffusion of both putamen and caudate nucleus heads [Figure 3].
View of hyphae in brain biopsy, showing positivity for periodic acid Schiff (PAS), in which regular hyphae are observed at acute angles, as is a round conidiophore on completion of the hyphae; PAS x400 (a). Stained hyphae with the Silver technique, showing reinforced walls, regular and septa that were observed with a more reinforced black color, forming acute angles characteristic of Aspergillus walls; Grocottmethenamine silver x400 (b)
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F4
The same result was reported with a histopathology, which showed a grayish color occipital tissue with the presence of infectious mycotic cerebral white-gray matter, giving a definitive diagnosis of brain tissue that tested positive for Aspergillus [Figure 4].