Case 10

A forty one-year-old male suffering from moisture cough and fever was given antibiotics from a local clinic. As high fever of 39 centigrade continued, he was introduced to our hospital for further investigation. He had a habit of drinking a lot of alcohol at night and smoking more than 20 cigarette pieces/day. He did not have a habit to brush teeth regularly and had several decayed teeth. At admission, abdominal pain, discomfort, headache and fever of 38.2 centigrade were found. Laboratory test revealed elevation of white blood cells of 16800 mm3 and CRP of 26.9 mg/dl and neutophils of 92.6 %. The patient received enhanced CT which depicted the suspicious mild appendicitis. Despite antibiotic administration, high fever continued.　Day 4 he received non-enhanced CT again to find the fever origin. The patient continued to appeal headache since admission. The referent chief doctor thought the used drugs caused disulfiram-like reaction to interrupt alcohol inducing headache. Day 9 his consciousness level decreased and right-sided conjugate deviation of the eyes was found. Gd-enhanced MRI of brain was eventually conducted.

What is the clinical diagnosis ?

1.Metastatic liver and cranial tumors

2.Liver cysts and subdural hematoma

3.Malignant lymphoma

4.Liver and subdural abscess

5.Cysticercosis (parasitic disease)

answer

2016.06.15