Case-Based Modules > Case 34 > Stage 2

Sorry! There are times where this would be appropriate-- for example, if your pre-test probability of infection was high and you didn't expect to find anything on the initial culture. There haven't been any findings suggestive of Listeria, in terms of CSF profile or culture (though cultures are often negative-- it's an intracellular organism), so it'd be reasonable to stop the ampicillin. At face value, with a negative HSV PCR, most would not fault us for discontinuing acyclovir.

However, there's something wrong here. This patient had a suspicious finding on MRI with the right-sided hemispheric (mainly temporal, occipital, insular) cortical diffusion restriction, along with right frontal-maximal LPDs on cEEG. What organism could be responsible for this constellation of findings?

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