A routine workup for suspected metastatic brain disease took an unexpected turn after a subtle MRI finding revealed an entirely different diagnosis. The case from Spain serves as a timely reminder that uncommon infections can occasionally appear in patients without the usual epidemiologic risk factors. A 60-year-old man from Castellón in Spain's Valencian Community presented with a two-week history of progressively worsening headache and mild behavioral changes . He had never traveled internationally and had no history of immunosuppression.
Neurologic examination showed only mild psychomotor slowing, while laboratory testing was largely unremarkable except for a mildly elevated serum IgE level. A noncontrast CT scan of the brain revealed multiple poorly defined intra-axial lesions accompanied by marked vasogenic edema , raising strong suspicion for metastatic disease. The patient was…
