Central nervous system toxoplasmosis in human immunodeficiency virus infection: Imaging findings

Abstract

Toxoplasmosis is one of the most common zoonoses worldwide caused by Toxoplasma gondii . Majority of T. gondii infections are asymptomatic or induce transitory and mild symptoms characterized by lymphadenopathy. Risk factors are immunosuppression and pregnancy. Human immunodeficiency virus (HIV) infected persons represent the group at highest risk of developing symptomatic toxoplasmosis especially with a CD4 count of <100, which can be fatal. A middle-aged acute-on-chronic ill-looking, conscious, lethargic but confused, pale man with lymphadenopathy involving the cervical, sub-mental and axillary nodes, and widespread fungal infections is presented. Neurologic imaging is frequently used in the diagnosis of central nervous system (CNS) toxoplasmosis in combination with serology and clinical assessment. Computed tomography scans show multiple, bilateral, contrast-enhancing (ring enhancing), focal brain lesions in 70-80% of patients with CNS toxoplasmosis. The course of disease can frequently be fatal if not recognized and treated early as was the case in this patient.