Case report

A 30-year-old man, previously well, had a 1-week history of high-grade fever and a 1-month history of subacute left hemiparesis, with dysarthria and angle of mouth deviation to the right. There had been three left-sided focal motor seizures with impaired awareness. On examination, he had a left upper motor neurone facial palsy, and moderate (3/5) left-sided limb weakness with brisk reflexes and an extensor plantar response. Routine investigations were normal, including viral markers for HIV, hepatitis B and C. MR scan of brain identified multiple punctate, linear and ring-enhancing lesions in the subcortical and deep white matter of the frontal, parietal and temporal lobes, thalamus, midbrain, dorsal pons and right middle cerebral peduncle showing diffusion restriction, suggesting microabscesses (figure 1). These showed tunnel-like enhancement …