This 35-year-old woman from Bolivia was admitted to the Emergency Department with an intense headache without any additional neurological complaint. Serology for human immunodeficiency virus was positive with a CD4-count of 70 cells/mm³. There was a history of several previous opportunistic infections such as toxoplasma, pneumocystis pneumonia, oral candidiasis, and asymptomatic chronic Chagas disease without adherence to treatment.

CT scan images demonstrated multiple intra-axial rim-enhancement lesions with perilesional edema and mass effect, which were confirmed at MRI.

Imaging features were non-specific and cerebral abscess of an unknown origin was suggested. Other differential diagnoses, including high-grade glioma, metastasis, toxoplasmosis, and cerebral lymphoma were less probable according to laboratory results (which showed IgG positive, PCR and microhematocrit concentration method positive for Trypanosoma cruzi and PCR negative for Toxoplasma Gondii).

After complete treatment for Chagas disease, PCR and microhematocrit concentration method for T. Cruzi became negative and follow-up images showed improvement of the cerebral lesions, with progressive decrease in size. Due to good clinical and radiological evolution and to avoid potential complications, brain biopsy was not considered and cerebral chagoma was assumed as the most likely diagnosis.