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Diffuse encephalitic toxoplasmosis in HIV.

Jasmine Pearce1, Ray Sheridan2, Johnathan Shaw3

  • 1Department of General Medicine, Royal Devon and Exeter Hospital, Exeter, UK jasmine.pearce1@nhs.net.

BMJ Case Reports
|March 19, 2021
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Summary

This case study highlights an unusual presentation of cerebral toxoplasmosis in an HIV-positive patient, showing diffuse white matter changes instead of typical ring-enhancing lesions on MRI. This atypical finding emphasizes the need for broader differential diagnoses in immunocompromised individuals.

Keywords:
infection (neurology)infectious diseasesneurology

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Area of Science:

  • Neurology
  • Infectious Diseases
  • Radiology

Background:

  • Cerebral toxoplasmosis is a common opportunistic infection in individuals with Human Immunodeficiency Virus (HIV).
  • Typical neuroimaging findings include ring-enhancing lesions on contrast-enhanced Magnetic Resonance Imaging (MRI).
  • Atypical presentations can mimic other central nervous system pathologies, complicating diagnosis.

Purpose of the Study:

  • To describe an unusual radiological presentation of cerebral toxoplasmosis.
  • To discuss the diagnostic challenges posed by atypical imaging findings.
  • To highlight the importance of considering toxoplasmosis even with non-classic MRI features.

Main Methods:

  • Case report of a 62-year-old HIV-positive patient.
  • Review of Magnetic Resonance Imaging (MRI) findings.
  • Correlation with laboratory results and treatment response.

Main Results:

  • The patient presented with diffuse white matter changes and ependymal enhancement on MRI.
  • These findings are atypical for cerebral toxoplasmosis, which usually presents as ring-enhancing lesions.
  • The radiological appearance initially suggested alternative diagnoses.

Conclusions:

  • Cerebral toxoplasmosis can exhibit atypical radiological manifestations.
  • Radiological findings alone may not be sufficient for a definitive diagnosis.
  • A high index of suspicion and consideration of the patient's immune status are crucial for diagnosing toxoplasmosis in HIV-positive individuals.