Cerebral toxoplasmosis

Case contributed by Dr Bahman Rasuli

Presentation

Patient with untreated HIV infection with sudden onset decreased level of consciousness.

Patient Data

Age: 45 years
Gender: Male
MRI

Multiple masses of variable size measuring from 8 to 23 mm with marked surrounding vasogenic edema and central restriction on DWI images are seen in the cerebral hemispheres including, corticomedullary junction, basal ganglia (right caudate nucleus), bilateral thalamus and choroid plexus in the right side. The masses themselves are iso to hyperintense to cortex on T2-weighted imaging, in contrast to the surrounding markedly T2 hyperintense vasogenic edema. The largest one is in the left thalamus.  Several have low T2 signal rims. All of the masses show ring enhancement after contrast injection. No intra-lesional calcification.

There is no midline shift or uncal herniation. No tonsillar herniation. No hydrocephalus. Normal paranasal sinuses. Mastoids are normal and the calvarium demonstrates no abnormality.

Case Discussion

Serology: Toxoplasma IgG + and CD4 < 100. Anti-toxoplasma therapy was initiated with the resolution of the findings.​

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Case information

rID: 66649
Published: 6th Mar 2019
Last edited: 14th Aug 2019
Inclusion in quiz mode: Included
Institution: Jame Jam Imaging Center

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