This 68 y/o male presented with weakness, fatigue, anorexia, weight loss, and night sweats. A change in mental status prompted a request for head CT. Selected images from his pre- and post-contrast head CT shown above demonstrate multiple "ring enhancing" lesions. This finding, the history, and the presence of a heart murmur led to the correct diagnosis of subacute bacterial endocarditis with multiple brain abscesses. Blood cultures were found to be positive for Staphylococcus aureus and vegetations were seen on the valves with cardiac echography.
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