Coexisting phaeohyphomycosis and tubercular central nervous system infections in an immunocompetent child: A case report

Figure 1 Serial neuroimaging of the child. A: Non contrast-computed tomography (CT) head during 3^rd week of illness showing multiple ring-enhancing lesions with surrounding oedema in the left temporo-parietal region; B: Magnetic resonance imaging (MRI) brain at 3^rd week of illness showing ring-enhancing lesions in the left temporal lobe (2 cm × 2 cm) and left caudate lobe (1.8 cm × 1 cm); C: MRI brain during 9^th week of illness showing nodular ring-enhancing lesions in the left temporal lobe measuring 34 cm × 2.8 cm (increased in size), with basal exudates and perilesional oedema; D: Magnetic resonance spectroscopy during 9^th week of illness showed choline, lipid, and lactate peak; E: Non contrast CT head multiple during 3^rd month of illness showing conglomerate ring-enhancing lesions in the left temporal lobe; F: Non contrast CT head at same time showing left temporal lobe abscess.

Figure 2 Microscopy of abscess material and a post therapy repeat magnetic resonance imaging brain. A: Pigmented fungal hyphae on direct microscopy of aspirated pus (arrow); B: Necrotizing granulomatous inflammation with central necrosis with multinucleate giant cell (arrow); C: Follow up contrast-enhanced magnetic resonance imaging brain after 6 weeks of amphotericin B showing resolution of abscess.