Diagnostic Dilemma

Ring enhancing granulomas on MRI brain and measles

A 7 years old girl presented with multiple episodes of convulsions in 7 days. She had first episode of generalized tonic clonic convulsion at 5 years of age with a frequency of once in 2-3 months and was on valproate for the same. She was off the anticonvulsants since last 1 year. She also had received antituberculous therapy {ATT} for 6 months a few years back {details not available} Her immunization, milestone and birth history is normal. On examination, she had multiple generalized lymphadenopathy and bilateral extensor planters. Other examination was normal. MRI of brain showed multiple calcified lesions in bilateral temperoparietal region with a solitary ring enhancing lesion at the base of the brain. CSF showed 8 lymphocytes with 1500 RBCs and normal sugar and protein. Her Mantoux test, Chest X-ray were normal. She was started on Dexamethasone for antiedema measures and was to be started on Albendazole as treatment for Neurocysticercosis but she developed fever and measles on second day of Dexamethasone and treatment for the granuloma had to be withheld. She was only continued on anticonvulsants.

What should the treatment be in this patient_?
Expert Opinion :
Thanks for the replies. HIV status of the child was negative. The child was not given any steroids. Once the measles improved, she was restarted on steroids and albendazole.
Answer Discussion :
prawin agarwal
12 years ago
drahmed alesawe
start epaneutin as anticonvulsions with manetol to decrease edema and stop steroid
12 years ago

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