Which mass is this? Diagnostic dilemma of an HIV patient presenting with intracranial mass

Abstract

Patients living with HIV (PLWHA) suffer from many medical condition, neurological complaints being one of the commonest. Intracranial masses are frequently found upon radiological examination on these patients. Differential diagnoses of intracranial mass in these patients vary, with several features overlapping each other, making diagnosis, and thus management, challenging. A patient diagnosed previously with HIV, a woman in her thirties, presented to the ER complaining headache for 2 weeks. Upon examination, she also exhibited left-sided hemiparesis and cranial nerve symptoms. A computed tomography (CT) scan showed multiple contrast-enhancing lesions with meningeal enhancement, which can be attributed to toxoplasmic encephalitis (TE), primary central nervous system lymphoma (PCNSL), progressive multiple leukoencephalopathy (PML), or tuberculous (TB) meningitis. Her toxoplasma serology came up positive, therefore the empirical treatment was focused on eliminating the parasite Toxoplasma gondii, as well as supportive therapy, after which she showed significant improvement in her clinical symptoms as well as brain imaging. Determining the etiology of intracranial mass in HIV patients are not always straightforward; consideration of several factors and administering therapy according to algorithms can deliver good outcome.