Multiple “rings” in the brain

A previously healthy woman in her late 60s presented with a four day history of fever, headache, and progressive visual loss. On examination she was drowsy, and her left eye showed mixed injection, hypopyon, and no visual perception. Brain magnetic resonance imaging (MRI) showed multiple ring-enhancing lesions (fig 1), and computed tomography showed low density liver lesions and cavitating pulmonary nodules.bmj;383/oct26_5/e077299/F1F1f1Fig 1Brain biopsy, metagenomic next generation sequencing of brain pus, and subsequent polymerase chain reaction assay identified abscess formation caused by serotype K1 hypervirulent Klebsiella pneumoniae species (hvKP). This hvKP serotype can lead to disseminated invasive infections resulting in endophthalmitis and brain abscesses.12 Differential diagnoses based on the MRI image include brain abscesses, neurocysticercosis, and neoplasm. The hvKP species is an unusual pathogen that has mostly been described in Asia and the Asian-Pacific rim. The brain abscesses in this patient resolved after treatment with intravenous antibiotics for eight weeks, although…
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