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Case of the Month - April 2013

Dr Lisa Frigati, Dr Helene Rabie, Prof Mark Cotton, Tygerberg Hospital

A 6-year old girl presented to Tygerberg Hospital EU with a 4-month history of headache, dizziness and intermittent vomiting. She had been living in the Eastern Cape and travelled to Cape Town the day before. She was HIV-exposed but tested ELISA-negative at eighteen months of age, had no known TB contact, and had received her full course of immunization. She had normal development and no history of trauma.

Her head circumference was 55.5cm (>98th centile), but the shape was asymmetric with a ‘bony swelling’ over the right temporal area. She had mild facial asymmetry, a Glasgow Coma Score of 14/15, decreased power (4/5) in left upper and lower limbs, and a hemiplegic gait. The rest of her examination was normal.

Full blood count and white blood cell differential was normal apart from thrombocytosis 556 X109/L. An urgent CT scan was requested:

Abdominal utrasound showed 7 simple liver cysts in the left and right lobes, the largest measuring 4.2 x 4cm.

Chest X-ray was normal.

Question 1: What is the diagnosis and describe the life cycle of the organism?

Continue to Answer 1