A 49/M with uncontrolled diabetes presented with fever (102- 103), headache and subacute onset of left sided hemiparesis. There was no history of skin and soft tissue abscess. On examination, he had no dental caries, sinusitis or ear infection. Chest X-ray was normal with no evidence of consolidation or infiltrates. His complete blood count showed TLC of 16,000 with neutrophilic predominance and raised ESR (81). HIV ELISA was negative. CT scan showed a ring enhancing space occupying lesion (RESOL) (3.4 X 3.2 X3.2 cm) in right thalamocapsular region with focal areas of cerebritis (Fig 1).
MR spectroscopy shows elevated lactate spikes (Fig 2)
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