PMC4925914_01
(A) CT chest showing patchy involvement of the lung with nodules, one shown here measuring 3.1 cm in greatest dimension. (B) CT abdomen and pelvis showing multiple low attenuation left sided mesenteric lymph nodes measuring 2.5 x 2.4 cm suggestive of necrotic lymphadenopathy (C) multiple microabscess of the liver (D) Mild splenomegaly at 12.5 cm (E) Enlarged prostate with heterogeneous low attenuation area with 2.9 cm x 2.0 cm area of fluid attenuation at the left posterior aspect that appears to arise from the prostate concerning for abscess, axial plane (F) prostatic abscess, sagittal plane.
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AmpliPrep/COBAS Taqman Analyzer, v2.0, Roche Diagnostics). Chest imaging was concerning for either multifocal pneumonia and/or possible opportunistic infection (Fig. 1A). Abdominal CT revealed necrotic mesenteric lymphadenopathy (Fig. 1B), micro-abscesses in the liver (Fig. 1C), and a 2.9 x 2.4 x 2.0 cm fluid attenuation collection posterolateral to the prostate suggestive of an abscess (Fig. 1D-E).
(A) 4+ AFB by auramine-rhodamine stain (B) Acid fast Kinyoun stain showing AFB stain positive organisms.
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The purulent fluid revealed 4+ AFB by auramine-rhodamine stain (Fig. 2A) and grew mTB complex. The direct Kinyoun stain is shown in Fig. 2B.
A and B. Representative axial images of MRI of the brain showing innumerable ring enhancing lesions with surrounding edema in both cerebral hemispheres (A), bilateral basal ganglia, midbrain and cerebellar hemispheres (B).
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MRI of the brain revealed multiple ring enhancing lesions with surrounding edema in the cerebral hemispheres bilaterally, the midbrain, and the cerebellar hemispheres bilaterally as well (Fig. 3A,B).