Concurrent Tuberculous Meningitis and Toxoplasma Encephalitis in an HIV-Positive Patient: An Exceptionally Rare Case

Human immunodeficiency virus (HIV) infection is strongly associated with an increased risk of opportunistic infections affecting the central nervous system (CNS). Among these, tuberculous meningitis (TBM) and Toxoplasma encephalitis (TE) represent two of the most frequent and severe infections seen in individuals with advanced immunosuppression. Each condition alone is associated with significant morbidity and mortality, particularly in patients with profoundly diminished CD4+ T-cell counts. While TBM and TE are common individually in the context of HIV/AIDS, their concurrent occurrence within the CNS appears to be exceptionally rare, with only rare or isolated reports in the literature. The co-existence of these infections poses substantial diagnostic and therapeutic challenges due to overlapping clinical manifestations, radiological findings, and the potential for rapid neurological decline. We report a case of a 46-year-old woman with long-standing HIV/AIDS, non-adherent to antiretroviral therapy, who presented with fever, headache, confusion, vomiting, and progressive neurological deficits. Cerebrospinal fluid analysis revealed lymphocytic pleocytosis with low glucose levels and a positive GeneXpert test for Mycobacterium tuberculosis. Toxoplasma IgG was markedly elevated, and brain MRI demonstrated multiple ring-enhancing lesions with surrounding vasogenic edema. Laboratory investigations confirmed advanced immunosuppression, with a declining CD4+ T-cell count and high viral load. She was treated with a combination of anti-tuberculous drugs, corticosteroids, and anti-Toxoplasma therapy. Despite treatment, her neurological condition deteriorated, with residual motor and cognitive deficits at discharge.