Cerebral Toxoplasmosis Presenting as a Medical Examiner Case

Abstract

Toxoplasma gondii is a common parasite, with infection rates ranging from 16–40% of the United States population to up to 80% in some Central and South American and European countries. Clinically significant toxoplasmosis is considerably rarer, primarily affecting those with compromised immune systems. In the era of widespread human immunodeficiency virus (HIV) testing and effective HIV therapies, toxoplasmosis is rarely encountered in the medical examiner setting. We report a case of previously undiagnosed cerebral toxoplasmosis in a prisoner not known to be HIV-positive, who was hospitalized and treated for a presumed head injury. Manifestations of toxoplasmosis, pathology, treatment, and outcomes are discussed. This case highlights the need for thorough autopsies not only for deaths apparently resulting from injuries in jails and correctional institutions, but also when prisoners are hospitalized for seemingly benign reasons, yet the cause of death remains unclear despite clinical evaluation and treatment.