Cerebral toxoplasmosis

Case contributed by Dr Ernest Lekgabe

Presentation

Presented with confusion. Background history of AML treated with bone marrow transplantation.

Patient Data

Age: 65
Gender: Male
MRI

MRI brain

Ring enhancing lesion in the right cerebral peduncle with a thick but smooth rim. The rim is relatively T2 hypointense. Surrounding vasogenic oedema and mass effect. Central restricted diffusion.

Pathology

MICROSCOPIC DESCRIPTION:

The sections show scattered chronic inflammatory cells in the parenchyma and in a perivascular distribution. They are mainly lymphocytes with some histiocytes. No neutrophils or eosinophils. There is one toxoplasma cyst containing bradyzoites (H&E stain). No tachyzoites. No granulomas or viral inclusions. The lymphoid cells show reactive changes. No evidence of malignancy.

Gram, Grocott and Ziehl-Neelsen stains (not shown) did not show presence of bacteria, fungi or acid fast bacilli, respectively. 

CMV and HSV1-2 immunostains (not shown) were negative. Most of the lymphocytes are CD3+ T-cells. No evidence of lymphoma/leukaemia.

Diagnosis:

Cerebral toxoplasmosis.

Case Discussion

Toxoplasmosis is an opportunistic infection in patients who are immunocomprised, either due to induced immunosuppression after organ transplantation, like in this case, or due to HIV/AIDS.  It is caused by the parasite toxoplasma gondii, and usually as reactivation of latent infection. A significant proportion of the population have a latent infection (seropositve for the parasite). Cats are the definitive hosts for the parasite. Primary CNS lymphoma is an important differential diagnosis, especially if the lesion is solitary.

 

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Case information

rID: 54575
Case created: 16th Jul 2017
Last edited: 18th Jul 2017
Inclusion in quiz mode: Included

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