The patient subsequently underwent a craniotomy and biopsy, which confirmed the presence of toxoplasmosis gondii on microscopy and immunohistochemistry. Patient was also newly diagnosed with HIV, with HIV-related immunosuppression thought to be the predisposing factor for neurotoxplasmosis. MRI features suggestive of neurotoxoplasmosis include:

  • peripherally-enhancing lesions of varying sizes distributed in the basal ganglia and grey-white matter junctions
  • extensive vasogenic edema surrounding the lesions
  • several lesions have a mural nodule e.g. right basal ganglia
  • the left frontal lobe lesion has a target-like pattern of enhancement, which can be seen in neurotoxoplasmosis