Mycotic Brain Abscess Caused by Opportunistic Reptile Pathogen

摘要

To the Editor: A 38-year-old,HIV-seropositive Nigerian mansought treatment with an 8-month his-tory of severe parietal headache,impaired memory, fatigue, paresthesiaof the left arm, and left-sided focalseizures. He had no history of neuro-logic disorders, including epilepsy.On physical examination, the patientappeared well, alert, and oriented,with slurred speech. Evaluation of thevisual fields showed left homony-mous hemianopsia. All other neuro-logic assessments were unremarkable.The patient had a blood pressure of120/80, a pulse of 88 beats perminute, and a body temperature of37.3°C. Leukocyte count was8,600/μL, total lymphocyte count was1,981/μL, CD4+ cell count was102/μL, and CD4/CD8 ratio was 0.07.HIV RNA-load was <50 copies/mL;all other laboratory parameters werenormal. The patient had received anti-retroviral therapy (stavudine, lamivu-dine, nevirapine) for 5 months beforeadmission, but no prophylaxis foropportunistic infections. Magneticresonance imaging (MRI) of the braindisclosed 2 masses, 3.3 and 4.8 cm indiameter, respectively (Figure A), andsigns of chronic sinusitis. A computedtomographic chest scan showed infil-tration of both lower segments withmultiple, small nodules (Figure B)