Sudden headache, fever, unconsciousness, this lesion is very hidden

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What should I do if the lesion is so small? Male, 35 years old, taking anti-rejection drugs for a long time after kidney transplantation
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Because of sudden headache, fever, unconsciousness, and positive meningeal irritation, he was watched because of meningitis reported by MRI in the emergency department
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Look at the image below, can you analyze it? ---Answer dividing line---Are you sure you want to see the answer? ▌ Clinical image analysis T2WI and FLAIR (figure AD) showed that the basal ganglia (obvious on the right) were piled or scattered in small dots (about 1mm) with high signal intensity, and the other side of the left lateral ventricle, left occipital lobe and right cerebellum A small circular high-intensity shadow with a size of about 3 mm can be seen, and the surrounding area of ​​the lesion is clear
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Enhanced scan (Figure E, F) The small round lesions on the left side of the ventricle were slightly enhanced, and some showed small ring enhancements.
Except for the enhancement of the cerebellar membrane, there was no enhancement of other lesions
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 ▌ Imaging diagnosis of cryptococcal encephalitis
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 ▌ Discussion points A.
There are many small spots or small round T2 hyperintensity lesions in the brain, a few have enhancement (may be cryptococcal tumors), and most have no enhancement (may be enlarged perivascular space or colloidal pseudocapsules), unlike tuberculosis Change, consider cryptococcosis and mild meningitis
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B.
Early cryptococcal disease lesions are often very small, and it is easy to miss the diagnosis without careful observation
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C.
Cryptococcosis is one of the common opportunistic infections in patients with low immunity.
In this case, a lumbar puncture of cerebrospinal fluid showed a positive result of cryptococcosis
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References: [1]Giovane RA, Lavender P D.
Central nervous system infections[J].
Primary Care: Clinics in Office Practice, 2018, 45(3): 505-518.
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