A 31-Year-Old Man With Seizures, Brain Lesion, and Lung Nodules

Abstract

A 31-year-old man was admitted to our hospital with a recent history of generalized seizures. Three months earlier, he started with intermittent hemoptysis. CT scan showed a cavitary lung lesion in the upper segment of the right inferior lobe (RIL). Because of his job as a social worker in a high-risk population, he started treatment for Mycobacterium TB; however, the BAL culture result was negative. At the time of his current admission, he has continued taking rifampicin, isoniazid, pyrazinamide, and levofloxacin. He denied the use of any illicit drugs or alcohol. He had no history of smoking. One year earlier, he visited Southeast Asia, Oceania, and South Africa for several months. He reported a weight loss of 7 kg since then. Except for a recurrent oral candidiasis, he did not have a relevant medical history. His family history was notable for mother with lupus, and brother with sarcoidosis.

Figure 1

Chest CT scan shows a nodular lung lesion in the upper segment of the right inferior lobe.

Figure 2

Brain MRI showing a right temporal-occipital nodule, which enhances with contrast.

Figure 3

Lung biopsy demonstrated noncaseating granulomas with giant cells (A, hematoxylin-eosin strain, 100×), and giant cell (B, hematoxylin-eosin strain, 200×).