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A 33‐year‐old man with multiple ring‐enhancing lesions in the brain

A 33-year-old male presented with inability to think clearly and not recalling the death of his younger brother who had unexpectedly died a few days earlier. Prior to this episode the patient had enjoyed his usual good state of health and worked as a correctional officer with negative HIV history. His memory continued to decline and he had increased lethargy. On physical examination the patient was afebrile without lymphadenopathy, organomegaly or skin lesions. A neurological examination revealed no focal deficits. Laboratory studies were all within normal limits, including a normal complete blood count (CBC) without lymphocytosis or abnormal circulating lymphoid cells. MRI revealed several hemorrhagic ring-enhancing lesions in the brain: one in the right temporal lobe and two in the left temporal lobe, and one in the right occipital lobe (Fig. 1). No other lesions were found in the chest, abdominal or the pelvic regions.