Neurocysticercosis with Classic Ring Enhancing Lesions in a Patient with AIDS: Case Report, Diagnostic Approach and Literature Review

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Introduction: Human immunodeficiency virus (HIV) is a neurotrophic, neuroinvasive, and neurovirulent pathogen, which can cause direct infection of the central nervous system (CNS) but also predisposes to a variety of other neuroinfections through impaired T-cell mediated immunity. Among the imaging findings in HIV patient with CNS infection, the presence of ring-enhancing intracranial lesions are considered not rare but quite puzzling diagnostic dilemma. The differential diagnosis for theses lesions commonly includes metastasis, abscess, glioblastoma, infarct, contusion, demyelinating disease, radiation necrosis, resolving hematoma or infections. Many features need to be considered altogether to help narrow the differential. Case description: Male, 32 years old, with history of chronic smoking, pets: one cat dewormed and vaccinated, and positive diagnosis of HIV infection with a CD4 T lymphocyte count of 24 cells/mm3, without antiretroviral treatment. His main symptom was headache, associated with fever, nausea, and vomiting. Therefore, he was hospitalized for his diagnostic approach. Complete laboratory work was done, head CT, lumbar puncture, and MRI, finding rounded intra-axial lesions with well-defined and hyperintense edges in the parietal and occipital region with annular enhancement after the administration of contrast. After symptomatic treatment and anthelmintic therapy, a follow-up imaging study evidenced involution of these lesions. The patient met diagnostic criteria for definitive diagnosis of neurocysticercosis. Conclusion: Even though, Neurocysticercosis is not a rare disease, our group decided to publish this case report because its asocciation with an HIV positive patient, in which has not been yet linked to, in behalf of the lack of evidence and studies, considering the ethical issue of performing rutinary head CT scans in asymptomatic individuals.