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A 28-year-old man presented with a history of fever, dry cough, headache and decreased responsiveness over 7 days. One year previously, he had suffered seizures and was hospitalised in another centre with an initial diagnosis of neurocysticercosis (NCC) and received treatment for it. MRI at that time depicted numerous ring enhancing lesions with eccentric scolex (‘cyst with dot’ appearance) in the cerebral hemispheres, subarachnoid space and orbits. The patient had a history of pork intake and intravenous drug misuse.
Physical examination at the time of admission revealed small, movable, painless subcutaneous nodules that were palpable over the arms, axillae and trunk. No abnormalities were noted on auscultation of the lungs. Blood and urine cultures were negative. Sputum analysis was normal. A chest x-ray revealed small nodules in both lungs (figure 1). A chest CT scan revealed …