Case 21 | Clinical Pathology Unknown Conference

1. Presented by Lucy Nam, JHU medical student and reviewed by Karen Carroll, MD

Clinical Vignette

A previously healthy adult presents from an outside hospital after reportedly having severe headaches for the past several months, followed by recent development of neck pain and memory problems. In the preceding weeks, the patient developed a cough and runny nose, and suffered several falls. Several days prior to admission, the patient presented to the outside hospital where imaging was performed. The MRI showed a frontal skull base lesion with a small lesion in the parietal area surrounded by significant edema (Figure 1). The CT scan of the chest, abdomen and pelvis showed left upper lung ground glass appearance, concerning for inflammatory changes. The patient was promptly transferred to another institution for neurosurgical management. A biopsy of the brain was stained and revealed the structures in Figure 2.

Prior to this incident, the patient had no significant health issues. Over the past several months, the patient lost approximately 30 pounds. The patient is has never had HIV testing performed.

On exam, the patient had a mild fever (99°) and all other vital signs were stable. The neck was supple and not rigid on exam. The abdomen was soft, nondistended, and without appreciable organomegaly. The neurological exam was grossly intact, without focal deficits and no obvious cranial nerve palsies. The labs are significant for decreased hemoglobin (11.1 g/dL), decreased hematocrit (34.3%), mild hyponatremia (134 mEq/L), and elevated glucose (137 mEq/L).

Figure 1. MRI demonstrating brain lesions

Figure 2. Histologic findings on brain biopsy (hematoxylin and eosin stain, 100x)

Question: Which is the most likely diagnosis in this patient?

Glioblastoma

Neurocysticercosis

Cerebral toxoplasmosis

Endocarditis

Metastatic disease

29 thoughts on “Case 21”

Thank you for writing this post. I like the subject too.

Thank you for your articles. They are very helpful to me. Can you help me with something?

Please provide me with more details on the topic

You helped me a lot with this post. I love the subject and I hope you continue to write excellent articles like this.

Thank you for your articles. They are very helpful to me. May I ask you a question?

Your articles are extremely helpful to me. May I ask for more information?

Good web site! I truly love how it is easy on my eyes and the data are well written. I am wondering how I could be notified whenever a new post has been made. I’ve subscribed to your RSS which must do the trick! Have a nice day!

Thank you for your help and this post. It’s been great.

Thank you for your articles. They are very helpful to me. Can you help me with something?

I appreciate you sharing this blog.Really looking forward to read more. Really Great.

Good article with great ideas! Thank you for this important article. Thank you very much for this wonderful information.

WOW! this article it really great i like it

Hey, i found a great site with so many games
Just click this >>> DetikToto <<<

I m going to bookmark your web site and maintain checking for brand spanking new information.

I really like reading through a post that can make men and women think. Also thank you for allowing me to comment! Watch bbc persian lıve

I am truly thankful to the owner of this web site who has shared this fantastic piece of writing at at this place.

This is my first time pay a quick visit at here and i am really happy to read everthing at one place

I do not even understand how I ended up here but I assumed this publish used to be great

Hi, just wanted to tell you, I liked this post.
It was helpful. Keep on posting!

Greetings from Idaho! I’m bored to tears at work so I decided to browse your
site on my iphone during lunch break. I really like the information you provide here and can’t
wait to take a look when I get home. I’m surprised at how fast your blog loaded on my cell
phone .. I’m not even using WIFI, just 3G .. Anyways, great site!

Have you ever thought about creating an e-book or
guest authoring on other sites? I have a blog
based upon on the same subjects you discuss and would love to have you share some
stories/information. I know my subscribers would appreciate
your work. If you are even remotely interested, feel free to shoot me an e-mail.

I must thank you for the efforts you’ve put in writing this blog.

I am hoping to see the same high-grade blog posts from you later on as
well. In truth, your creative writing abilities has encouraged
me to get my own site now 😉

You really make it seem so easy with your presentation but I find this topic to be
actually something which I think I would never understand.
It seems too complicated and extremely broad for me. I’m looking forward for your next post, I’ll try to get the hang of it!

You need to be a part of a contest for one of the most useful blogs on the net.
I am going to recommend this web site!

My relatives all the time say that I am wasting
my time here at web, however I know I am getting know-how everyday by reading
thes good content.

I’m truly enjoying the design and layout of your site. It’s a very
easy on the eyes which makes it much more enjoyable for me to come
here and visit more often. Did you hire out a developer
to create your theme? Fantastic work!

Oh my goodness! Impressive article dude! Thank you
so much, However I am having difficulties with your RSS.
I don’t understand the reason why I cannot join it. Is there anybody else getting identical
RSS issues? Anybody who knows the solution will you kindly respond?

Thanks!!

I like the efforts you have put in this regards for all the great content.

I just like the helpful information you provide in your articles

You’ve made some good points there. I checked on the web
to find out more about the issue and found most people will go along
with your views on this web site.

29 thoughts on “Case 21”

Leave a Reply