PMC9992866_01
(A) Timeline of an episode of care. The patient contracted COVID-19 with mild symptomatology. Thirty days later, the patient was diagnosed with pneumonia and at day 60, presented with hemiparesis. MRI revealed a cerebral lesion. At day 85, the patient presented worsening neurological symptoms and a second MRI showed an additional lesion as well as an increased size of the primary cerebral lesion. At this time, a second biopsy confirmed N. farcinica. (B) MRI imaging showing an abscess involving the high convexity on the right of the frontal lobe measuring ~1.9 cm x 1.7 cm associated with marked adjacent vasogenic edema (a, b). On repeat imaging, an increase in the size (2.9 cm) of the ring enhancing posterior right frontal/anterior parietal lobe is seen, as well as a new ring-enhancing posterior right frontal lobe lesion measuring 1.1 cm, superior to the lesion described prior (c, d).
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PMC9992866_03_fneur-14-1137024-g0001.jpg
F1
After this initial visit, the patient presented three additional times to emergency services over the course of 3 weeks (Figure 1A). Upon the second admission, an MRI was performed, which indicated a cerebral abscess rather than an ischemic stroke (Figures 1A, B). The growth of the abscess prompted a second neurological biopsy and Public Health Laboratory testing, which revealed the presence of N. farcinica (Figure 1B).
(A) Modified acid-fast staining on biopsy showing acid-fast rods. (B) Grocott staining.
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F2
Farcinica (Figures 2A, B).
PMC9992866_02
PMC9992866_03
(A) Timeline of an episode of care. The patient contracted COVID-19 with mild symptomatology. Thirty days later, the patient was diagnosed with pneumonia and at day 60, presented with hemiparesis. MRI revealed a cerebral lesion. At day 85, the patient presented worsening neurological symptoms and a second MRI showed an additional lesion as well as an increased size of the primary cerebral lesion. At this time, a second biopsy confirmed N. farcinica. (B) MRI imaging showing an abscess involving the high convexity on the right of the frontal lobe measuring ~1.9 cm x 1.7 cm associated with marked adjacent vasogenic edema (a, b). On repeat imaging, an increase in the size (2.9 cm) of the ring enhancing posterior right frontal/anterior parietal lobe is seen, as well as a new ring-enhancing posterior right frontal lobe lesion measuring 1.1 cm, superior to the lesion described prior (c, d).
fneur-14-1137024-g0001.jpg
PMC9992866_03_fneur-14-1137024-g0001.jpg
F1
After this initial visit, the patient presented three additional times to emergency services over the course of 3 weeks (Figure 1A). Upon the second admission, an MRI was performed, which indicated a cerebral abscess rather than an ischemic stroke (Figures 1A, B). The growth of the abscess prompted a second neurological biopsy and Public Health Laboratory testing, which revealed the presence of N. farcinica (Figure 1B).
PMC9992866_04