Central nervous system toxoplasmosis with atypical neurologic findings in an immunocompetent patient

Central nervous system toxoplasmosis usually occurs in immunocompromised patients and is associated with severe clinical findings. It is rare in immunocompetent individuals.

A young patient presented with mild neurologic findings. Brain magnetic resonance imaging (MRI) with intravenous gadolinium contrast revealed a calcified lesion with mixed signal intensity in the cerebellum surrounded by mild edema and showing mild enhancement. Elevated immunoglobulin G and M titers for Toxoplasma gondii were found. A comprehensive diagnostic workup for other infectious, autoimmune, malignant, and immunosuppressive conditions yielded no clinically significant findings. Other common sites of toxoplasmosis involvement were excluded.

Treatment with sulfamethoxazole-trimethoprim resulted in improvement of headaches and neurologic signs. At the 2-year follow-up, serial brain MRI scans showed no clinically significant changes apart from the absence of contrast enhancement. Clinically, the patient reports intermittent migraine-like headaches and a mild tremor in both upper limbs. No evidence of immunodeficiency was identified, supporting a final diagnosis of central nervous system toxoplasmosis in an immunocompetent patient.

Central nervous system toxoplasmosis can occur in immunocompetent individuals, even with mild or atypical neurologic presentations. Brain MRI and serum serology are crucial for diagnosing these cases.