Department of Pathology, University of Oklahoma Health Sciences Center
An 8 year-old boy with new onset generalized seizure.
Clinical information: The patient was an 8 year-old Caucasian boy with an unremarkable past medical history who presented to the emergency department with new-onset generalized seizures. The patient's mother reported a "fever" that occurred about one week prior to presentation and the fever lasted for about four days. The fever was not associated with upper respiratory or other constitutional symptoms. He had dental work 5 months prior to presentation, and had visited Florida two months prior, swimming in multiple pools and in the sea. Physical examination, including neurological exam, and blood/urine laboratory data were unremarkable. No cerebrospinal fluid was obtained. An MRI with gadolinium revealed a small enhancing mass in the left frontal lobe as illustrated below.
After a blood culture was obtained, the patient was started on triple antibiotics and brought to the operating room for a left frontal craniotomy with biopsy. A frozen section and touch preparation revealed acute inflammation with probable microabscess formation. Gram stain on tissue sent for aerobic, anaerobic, fungal, acid-fast bacilli, and amoebic cultures revealed no organisms. Representative images of the permanent sections are presented as follows:
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Cases of the Month Coordinator: KarMing-Fung@ouhsc.edu