PMC9194585_01
Hospital course of the patient from admission (day 0) to the day of discharge (day+44). Lymphocytopenia (defined as count <1000 cells/microL) and severe neutropenia (defined as count <500 cells/microL) were present from day 0 to day+ 21 and colored in grey. Significant clinical events and sequential antibiotic treatment were indicated above and below timeline, respectively.
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Peripherally inserted central venous catheter was placed on admission (Fig. 1).
MRI imaging of brain on hospital day 34. Axial T2W (A), contrast enhanced T1W (B), B1000 DWI (C), ADC diffusion map (D), and SWI (E) MRI images of the brain demonstrate a ring enhancing lesion right frontal cortex (black arrow) with associated dural thickening and enhancement over the right frontal cortex (white arrows) and surrounding vasogenic edema (white block arrow). The lesion demonstrated restricted diffusion seen as increased signal on DWI and decreased signal on ADC map images (open block arrow) as well as evidence of petechial hemorrhage seen on SWI (black block arrow). Sagittal contrast enhanced T1W (F) MRI image of the brain demonstrates ring enhancing lesions frontal and temporal lobe (white arrows) and smaller solid enhancing lesion frontal cortex (black arrow).
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On hospital day 34, repeat brain MRI was obtained and was significant for interval progression of brain lesions (Fig. 2).