An unusual cause for rings in the brain

Abstract

We report the case of a 35-year-old man from North India who presented with generalised tonic-clonic seizures and was found to have ring-enhancing brain lesions. He had a coincident adrenal mass lesion. Cultures from both regions grew Histoplasma capsulatum. He improved on treatment with itraconazole. This case is being reported since cerebral ring-enhancing lesions are rarely associated with histoplasmosis, and coincident adrenal involvement is also a rarity in an immunocompetent individual.