PMC5007420_01
Chest radiograph showing a wedge-shaped nodular opacity measuring 3.1 x 3.25 cm in the left upper lobe adjacent to the pleura.
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CD4 count was 449 x 10 (6)/L and his HIV serology was non-reactive. Chest radiograph however revealed wedge-shaped nodular opacity measuring 3.1 x 3.25 cm in the left upper lobe adjacent to the pleura (Fig. 1).
Chest CT scan showing subpleural mass in the lateral aspect of the left upper lung lobe and a smaller spiculated and eccentrically cavitary 1.4 cm nodule in the posterior and subpleural aspect of the left lower lobe.
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A computed tomography (CT) of the chest and abdomen with intravenous contrast revealed a large spiculated 2.8 x 4.5 x 3.7 cm subpleural mass in the lateral aspect of the left upper lung lobe and a smaller spiculated and eccentrically cavitary 1.4 cm nodule in the posterior and subpleural aspect of the left lower lobe (Fig. 2).
MRI of the head with gadolinium shows a T2 hypointense lesion involving the left head of the caudate nucleus with perifocal edema suspicious for a fungal abscess.
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Initial computed tomography of the head was normal but a follow up Multisequence Multiplanar Unenhanced Magnetic Resonance Image (MRI) of the head with gadolinium showed a T2 hypointense lesion involving the left head of the caudate nucleus with perifocal edema suspicious for a fungal abscess (Fig. 3).
CSF culture showing beaded branching gram positive bacilli.
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Further susceptibility testing showed the organism was susceptible to amoxicillin/clavulanic acid, imipenem, linezolid, moxifloxacin and trimethoprim/sulfamethoxazole (TMP-SMX) but resistant to ceftriaxone (Fig. 4).