A 62-year-old man presented with a 7-day history of progressive headache and right-sided weakness. The patient was a kidney transplant recipient, 16 years ago, because of diabetic nephropathy. Medications included prednisone and mycophenolate mofetil. Examination revealed right hemiparesis. Brain MRI showed a frontal space-occupying lesion on the left side (figure 1). Serology results were noncontributory. Biopsy was inconclusive. Surgery was performed, and pathology confirmed cytomegalovirus (CMV) infection (figure 2). The patient improved after receiving ganciclovir.CMV infection of the nervous system in adults usually affects immunosuppressed patients. Common neurologic manifestation includes polyradiculoneuropathy, myelitis, and encephalitis. Neuroimaging features include periventricular abnormalities.1 In rare cases, CMV may present as pseudotumoral lesions.
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AUTHOR CONTRIBUTIONSV.H.R. Marussi: conception, organization, and execution of the case report project, writing of the first draft and review and critique of the manuscript. J.L. Pedroso: conception, organization, and execution of the case report project, writing of the first draft and review and critique of the manuscript. L.F. Freitas: conception, organization, and execution of the case report project, review and critique of the manuscript. A. Baeta: conception, organization, and execution of the case report project, writing of the first draft and review and critique of the manuscript. C.L. Lancellotti: conception, organization, and execution of the case report project, writing of the first draft and review and critique of the manuscript. O.G. Barsottini: conception, organization, and execution of the case report project, writing of the first draft and review and critique of the manuscript. A.S.B. Oliveira: organization and execution of the case report project, review and critique of the manuscript. L.L.F. Amaral: organization and execution of the case report project, review and critique of the manuscript.