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A 26-year-old woman from Pakistan presented to our institution in New York with episodic right-sided weakness and expressive aphasia. She was at 36 weeks’ gestation of an uncomplicated third pregnancy. On presentation, the patient appeared well, had normal vital signs and was afebrile. Her neurological examination was normal between recurrences. The patient reported usual fetal movement, and fetal monitoring displayed a reassuring tracing. MRI of the brain without gadolinium revealed numerous ring-like hyperintense lesions most consistent with an inflammatory or infectious aetiology (figure 1A). CT of the chest demonstrated multiple bilateral lung nodules with areas of coalescence (figure 1B). The patient denied respiratory symptoms. HIV and vasculitis testing was negative. Interferon gamma release assay had been positive earlier in the pregnancy. Lumbar puncture was performed: there was an elevated opening pressure, lymphocytic pleocytosis, low glucose and high protein. Cerebrospinal fluid smear for acid-fast bacilli (AFB) …
Contributors Conception of manuscript: all authors. Pathology image acquisition and processing: LH. Writing of manuscript: LM, OE. Review and approval of manuscript: all authors.
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; internally peer reviewed.