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A single-celled organism dangerous only when transmitted to patients who are immunosuppressed or pregnant, prompted a detailed work-up. The patient, a 70-year-old woman with new-onset mental status changes, was transferred from an outside hospital for evaluation of a lesion in her right basal ganglia.

Three years earlier, she had a combined liver and kidney transplant. The procedure was necessitated by hepatic encephalopathy secondary to intrahepatic portacaval shunting and end-stage renal disease secondary to membranoproliferative glomerulonephritis. While undergoing surgery, the patient developed paroxysmal atrial fibrillation with rapid ventricular response, and subsequently, a right atrial thrombus that then migrated to the right ventricle. She was administered tissue plasminogen activator, and multiple intracranial hemorrhages ensued. During the postoperative hospitalization period, the patient …