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A 39-year-old Portuguese male was found obtunded and incontinent of urine. On admission, his Glasgow Coma Scale (GCS) score was 14/15. He had fever, left-sided facial weakness and mydriasis, and bilateral clonus. Cranial CT and MRI demonstrated multiple supra- and infra-tentorial contrast-enhancing lesions, surrounding oedema and hydrocephalus (figures 1 and 2). Chest radiography and CT revealed two right upper lobe cavitating lesions (figure 3). No ear, sinus or dentition abnormalities were detected. He had no history of intravenous drug use or significant medical history. His white cell count (WCC) was 24.8×109/l (reference range: 4.0–11.0×109/l) …
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