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An adult man with well-controlled HIV (taking emtricitabine/tenofovir disoproxil fumarate and raltegravir) presented with 1–2 months of gradual-onset generalised headache, preceded by a diffuse symmetrical rash. He was afebrile and there were no abnormal neurological examination findings.
A CT scan of the head showed multiple lytic calvarial lesions, with destruction of the inner and outer tables and diploic space (figures 1 and 2). On MRI, the lesions were hyperintense on the T2-weighted and fluid-attenuated inversion recovery (FLAIR) sequences, with restricted diffusion and enhancement (figure 3). A CT of his body was unremarkable apart from mild bladder wall thickening (a cystoscopy was subsequently normal).
Contributors All authors made a substantial contribution to the work. JG: in the drafting the initial effort, JG and GD: in acquiring and reviewing the images, and JG, GD, MB and ND: in manuscript review, editing and revision.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed by Nick Silver, Liverpool, UK.