Fulminant and Diffuse Cerebral Toxoplasmosis as the First Manifestation of HIV Infection: A Case Presentation and Review of the Literature.

BACKGROUND One of the most common causes of central nervous system (CNS) opportunistic infections in immunocompromised patients is toxoplasmosis. It can cause focal or disseminated brain lesions leading to neurological deficit, coma, and death. Prompt management with optimal antibiotics is vital. However, the diagnosis of cerebral toxoplasmosis is challenging in infected individuals with human immunodeficiency virus (HIV). The possible diagnosis is based on clinical presentation, imaging, and specific serologic investigations. The diagnosis can be confirmed by histopathological examination and/or by finding nucleic material in the spinal cerebrospinal fluid (CSF) examination. CASE REPORT We present a review of the literature with a rare illustrative case of diffuse CNS toxoplasmosis as the first manifestation of HIV infection in a young patient. Brain MRI showed diffuse, ring-enhancing lesions, and significant midline shift. Decompressive hemicraniectomy for control of intracranial pressure and anti-infectious therapy were performed. CONCLUSIONS This should raise awareness that cerebral toxoplasmosis can occur in pediatric patients with HIV infection, and, more importantly, as the first manifestation of AIDS. Although the prognosis is often poor, early diagnosis and immediate treatment of this life-threatening opportunistic infection can improve outcomes.

Intra-cranial Toxoplasmosis in an Immunocompetent Female.

Intra-cranial toxoplasmosis is a rare entity occurring mostly in immunosuppressed individuals. It is extremely rare in an immune competent patient. Toxoplasmosis is the third leading cause of food borne illness. Depending upon the site, degree of inflammation and local damage, toxoplasmosis encephalitis and cranial abscess can cause long lasting neurologic sequel. With modern imaging techniques, toxoplasmosis antibody titers, slit lamp examination and brain biopsy, there is improvement in diagnosis along with reduction in the mortality rate. We present a case illustrating the radiological manifestations, complications, potential pitfalls in diagnosis and treatment of intra-cranial toxoplasmosis in immunocompetent patient.

Sellar Toxoplasmosis and Nonfunctioning Pituitary Adenoma.

BACKGROUND: Sellar toxoplasmosis is associated with congenital infections or immunodeficiency. The finding of Toxoplasma bradycysts in a pituitary adenoma is very unusual. CASE DESCRIPTION: An otherwise healthy 27-year-old woman presented with secondary amenorrhea and moderately elevated prolactin levels. A macroprolactinoma was suspected on magnetic resonance imaging, and cabergoline was initiated. Although dopamine levels decreased, the tumor did not show significant shrinkage; after 2 years, transsphenoidal resection was indicated to clarify the diagnosis and to cure hyperprolactinemia. Histology showed an inactive pituitary adenoma and Toxoplasma bradycysts. Seropositivity for Toxoplasma gondii, but neither immunodeficiency nor intracerebral spread, was found. During a postoperative follow-up period of 15 months, the patient did not show any recurrence. CONCLUSIONS: Sellar toxoplasmosis in conjunction with pituitary adenoma is extremely rare. Nonfunctioning lesions should be suspected in cases of sellar masses and moderate hyperprolactinemia.

Intracranial inflammatory granuloma caused by toxoplasmosis.

Toxoplasmosis is a serous parasitic zoonosis caused by the protozoan Toxoplasma gondii worldwide. Human beings acquire the disease by eating infected meat containing T. gondii cysts, by ingesting water or vegetables contaminated with oocysts shed in the feces of an infected cat, and by transmission from mother to fetus. Cerebral toxoplasmosis is one of the most serious complications in immunocompromised individuals such as HIV-infected patients, with a high mortality rate, whereas the incidence of cerebral toxoplasmosis is extremely rare in immunocompetent persons. Due to the low incidence and the high rate of misdiagnosis, cerebral toxoplasmosis was occasionally described in sporadic cases. (1) Furthermore, the diagnosis of cerebral toxoplasmosis is rather difficult because the clinical manifestations are non-specific and are not sufficiently characteristic for a definite diagnosis. It mimics several other infectious diseases or primary central nervous system (CNS) tumor. (2) In the present study, we reported an exceedingly rare cerebral toxoplasmosis with obvious space-occupying lesion occurring in the left temporal lobe of an immunocompetent adult patient. To our knowledge, this is the first report of successful treatment of acquired cerebral toxoplasmosis in China.

[Multiple intracranial lesions: a clinicalpathologic study of 62 cases].

OBJECTIVE: To study the clinicalpathologic features of intracranial multiple lesions. METHODS: The clinical, radiologic and pathologic features of intracranial multiple lesions in 62 cases during the period from 2005 to 2009 in Xuanwu Hospital were retrospectively reviewed. RESULTS: There were 32 males and 30 females in 62 cases. The mean age of seize onset and duration of disease were 37.4-year-old and 11.6 months, respectively. The lesions could affect cerebral hemisphere, basal ganglia, brain stem, cerebellum and other parts, most lesions were located above the tentorium. Pathological diagnosis as follows: 13 patients with glioma; metastatic tumors in 13 cases; 12 cases of central nervous system infection; immune-mediated inflammatory demyelinating disease in 8 cases; 5 cases of primary lymphoma of central nervous system; primary angiitis of the central nervous system 3 cases; mitochondrial encephalopathy 2 cases; vein thrombosis in 2 cases; Rosai-Dorfman disease in 2 cases; 2 case of radiation encephalopathy. Among them, mitochondrial encephalopathy and vein thrombosis lesions located in the cortex; metastatic tumor and blood-borne infection mainly involving junction of grey and white matter; glioma, radiation encephalopathy and demyelinating disease include white matter lesions; vascular inflammation showed cortical and subcortical white matter lesions. CONCLUSIONS: A variety of tumor and non-neoplastic diseases can be expressed in intracranial multiple lesions, which gliomas, metastatic tumor and central nervous system infections are more common. In order to improve the diagnosis of intracranial multiple lesions, active work in the brian biopsy, study the clinical, imaging and pathological findings must be closely.

A case of cerebral toxoplasmosis in a pregnant non-immunocompromised patient.

Cerebral toxoplasmosis, a disease of immunocompromised individuals, is rare in immunocompetent persons. We present a case of cerebral toxoplasmosis in a non-immunocompro-mised pregnant woman. Her imaging studies revealed a mass lesion involving the right basal ganglia, periventricular grey matter, midbrain and pons suggesting a neoplastic pathology along with hydrocephalus. She underwent an endoscopic third ventriculostomy and biopsy of the lesion. Postoperatively her consciousness improved as the hydrocephalus was relieved. After a thorough gynaecological examination she gave birth to a healthy child via normal vaginal delivery. The histopathology examination of biopsy suggested an inflammatory pathology. Serological studies for toxoplasmosis were positive. After 6 weeks of anti-toxoplasma treatment follow-up imaging showed a significant decrease in the size of the lesion.

HIV related toxoplasmic encephalitis mimicking multiple metastasis: case report.

We report a case of toxoplasmic encephalitis (TE) in a young woman without prior history of human immunodeficiency virus (HIV) infection. She was referred to our clinic with a diagnosis of multiple metastases following cerebral magnetic resonance imaging (MRI) revealing multiple ring-enhanced mass lesions. She had suffered from headaches for four weeks and there had been new onset of confusion and left hemiparesis. Soon after hospitalization, her neurological status rapidly deteriorated and she was operated for decompression. Pathology examination revealed TE and her blood samples were found to be HIV positive. We conclude that TE should be considered in the differential diagnosis of multiple lesions in sexually active individuals including cases without a prior history of HIV infection.

An algorithmic approach to intracranial mass lesions in HIV/AIDS.

We developed a diagnostic and therapeutic algorithm for intracranial mass lesions in patients with HIV/AIDS that obviates the need for neurosurgical intervention. The approach is based upon CD4(+) lymphocyte count, serum toxoplasma immunoglobulin G (IgG) serology, chest X-ray, routine lumbar puncture studies, cerebrospinal fluid (CSF) cytology, CSF adenosine deaminase or Mycobacterium tuberculosis polymerase chain reaction testing, single positron emission-computed tomography (SPECT) scanning for intracranial enhancing lesions, and limited therapeutic trials. Over a 12-month period involving 26 patients, we found that the algorithm correctly identified the aetiology of focal intracranial lesions in all 23 evaluable patients. Costs for SPECT scanning for the entire study cohort were more than offset by the savings achieved by reduced hospital stays for the four patients with lymphoma alone. An algorithmic approach can accurately identify the cause(s) of central nervous system (CNS) mass lesions in HIV-infected patients, and SPECT scanning can replace stereotactic brain biopsy in most cases where opportunistic malignancy is suspected.

White matter fiber tracking in patients with space-occupying lesions of the brain: a new technique for neurosurgical planning?

The technique of fiber tracking based on diffusion tensor imaging offers the unique possibility of localizing the white matter pathways of the brain in vivo. In patients with cerebral tumors or space-occupying lesions of the brain, these pathways are often damaged or significantly displaced. Knowledge of the exact location of the lesion with respect to clinically eloquent white matter pathways is of great value to the neurosurgeon in planning the appropriate surgical strategy. We present here preliminary findings using the fiber tracking technique in four patients with space-occupying lesions and discuss the potential and limitations of the technique for lesion localization and neurosurgical planning.

Sudden appearance of multiple brain lesions in Aids after a cerebral biopsy. Case report

A unique case of cerebral toxoplasmosis which had an acute appearance of multiple discrete lesions following a biopsy and its neuroradiological findings are reported in detail. Possible pathophysiological mechanism are presented

Sudden appearance of multiple brain lesions in Aids after a cerebral biopsy. Case report.

A unique case of cerebral toxoplasmosis which had an acute appearance of multiple discrete lesions following a biopsy and its neuroradiological findings are reported in detail. Possible pathophysiological mechanism are presented.

Unilocular toxoplasmosis simulating intracerebral tumor.

Toxoplasmosis is a common infection with increased incidence in patients suffering from AIDS. In this paper we report a rare case of toxoplasmosis without evidence of AIDS: The patient had a singular tumor-like lesion in the right parietal lobe in CT and MRI. In neurosurgical intervention no tumor was found. Finally, different histopathological examinations led to the diagnosis of toxoplasmosis. Diagnostic and therapeutic regimes in patients with suspect tumor-like lesions should be discussed.