CTLA4 deficiency autoimmune disease, inflammatory arthritis, AIHA status post splenectomy on Rapamune, pulmonary nodules, now presenting with new onset severe headache and nausea/vomiting. There are multiple infiltrative cortical and white matter enhancing lesions with high T2 signal within the right frontal lobe, bilateral parietal lobes, occipital lobes, left insula, and right cerebellum, which are generally more prominent. In addition, there is a newly apparent subcortical enhancing lesion in the left middle frontal lobe. The lesions display minimal mass effect and there is no midline shift. There are no associated susceptibility or restricted diffusion. There is an unchanged linear T2 hyperintense lesion in the superior right frontal white matter without associated enhancement. The ventricles and basal cisterns are normal in size and configuration. There is diffuse paranasal sinus mucosal thickening and fluid levels in the maxillary sinuses. There are partially-imaged prominent cervical lymph nodes, particularly on the left side. The orbits are unremarkable.
1. Slightly increased prominence of multiple supratentorial and infratentorial lesions may represent lymphocytic infiltration associated with CTLA4 deficiency versus lymphoma. 2. Partially-imaged prominent cervical lymph nodes, particularly on the left side may also be related to the autoimmune disorder or lymphoma.3. Findings suggestive of acute sinusitis.