50 yr old MALE HYPERTENSIVE N CKD RECENT RENAL TRANSLPLANT (1 MONTH )ON IMMUNOSUPPRESSIVE RX. PRESENTED WITH LEFT HEMIPARESIS AND SLURRING OF SPEECH WITH PRESERVED SENSORIUM ... SO PLZ THINK OUT OF BOX AND REPLY . THANKS :)

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Ring enhancing lesion Post transplant D/d PTLD Aspergillosis Nocardia Coccidiomycosis CMV/EBV TB Cryptococosis and mets Csf for infection etiology and other body part screening for carcinoma differentiation needed

Asper....
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FLAUR hyperintense lesion with peripheralisointensity with perilesion edemam RTputaminocapsular area .In addition there is hyperintense lesion LT parietal area also.After contrast there is ring enhancing lesion noted in the LEFT parietal area & not on the RT side. Possibilities: primary lymphoma brain vs Toxoplasmosis

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Mri brain- basal ganglia lesion with perilesional edema MRI CONTRAST S/O - ring enhancing basal ganglia LESION Case of post renal transplant status on immuno suppressant PossibilIty of CNS toxoplasma most likely than other possibility Common site of toxoplasma in basal ganglia Pls -do CD 4 count if less than 100 And also do toxoplasma antibody. Give treatment trial of sulfadiazine with pyrimethamine +Steroid Repeat mri brain after 3 weeks.

Reduce immunosuppressive drug dose
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It's only 1 month post transplant with ring enhancing CNS lesions suggestive of.. Toxoplasmosis TB Cryptococcal infection Less likely PTLD (EBV induced post transplant lymphoproliferative disorder)

After thorough Ix n csf aspergillus Ag was positive So its CNS ASPERGILLUS INFECTION AMPHOTERICIN B STARTED ACCORDING TO GFR UNDER NEPHRO, INFECTIOUS DIS SPECIALIST AND NEURO OBSERVATIONS PT DOING WELL . THANKS ALL FOR THE PARTICIPATION...

Thanks Dr Ravi for the feed back. Every case teaches us irrespective of our experience
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Fungal infection (mucormycosis)

Fungal Aspergillus
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Ryan extensive in trace reveal haemorrhage involving ethnic internal capsule, lenticular nucleus & involving thalamus

Cerebro vascular strock

ICH or Sporadic cerebral amyloid angiopathy

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