BMJ Case Reports 2013; doi:10.1136/bcr-2013-009141

Ring lesions in the brain: a harmless commensal?

  1. Robin Howard2
  1. 1Department of Respiratory Medicine, Watford General Hospital, Watford, UK
  2. 2Department of Neurology, St Thomas’ Hospital, London, UK
  1. Correspondence to Dr Justin Garner, justin.garner{at}, justingrnr{at}


A 72-year-old gentleman, type 2 diabetic, was admitted in the hospital with a head injury which was a result of a fall. Several weeks before, he had been investigated and treated for a community-acquired pneumonia, left pleural effusion and confusion. CT brain showed right frontal encephalomalacia.

On re-examination, drowsiness, extensor plantar responses and signs of a left pleural effusion were recorded. He was afebrile.

His white cell count was 12.3 (4.0–11.0×109), neutrophils 10.8 (1.5–7.0×109), C reactive protein 5 (0–4) mg/l, urea 5.0 …

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