PMC6660599_01
(A) Computed tomography of the brain with contrast showed multiple small rim-enhancing lesions with marked perilesional vasogenic edema scattered at the gray and white junction of the bilateral cerebral hemisphere. (B) Computed tomography angiography of the brain showed a lobulated saccular outpouching lesion arising from the anterior branch at M2 segment of the left middle carotid artery (red arrow). (C) A modified acid-fast staining of the pus from the right chest wall showed beaded filamentous branching organisms with few white blood cells. (D) Gram's staining of thrombus inside the aneurysm showed few clusters of Gram-positive filamentous bacilli (arrow).
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Emergency computerized tomography (CT) scan of the brain showed subarachnoid hemorrhage and multiple scattered small rim-enhancing lesions (Fig. 1A). CT angiogram of the brain revealed lobulated saccular outpouching lesion at the left middle carotid artery, suggestive of a ruptured mycotic aneurysm (Fig. 1B). The modified acid-fast staining of the aneurysm and thrombus revealed beaded branching organisms (Fig. 1C). Histopathological findings revealed presence of thrombus and a few clusters of Gram-positive filamentous bacilli (Fig. 1D).