Review of Toxoplasmic Encephalitis in HIV Infection; a Case Study

Infection with Human Immunodeficiency Virus (HIV) causes a spectrum of clinical problems in multiple organs. It may affect the nervous system directly, producing distinct neurological syndromes, or indirectly, by causing immunodeficiency with a resultant susceptibility to opportunistic infections such as Toxoplasma gondii. In this case study, we described a 47-year-old man who admitted to our emergency department with fever and confusion progressing from two days before the admission. He was candidate for biopsy 20 days before due to acute onset left-side hemiplegia and right-side ptosis and imaging findings consistent with a brain mass. Due to these findings and positive histories of lung tuberculosis and esophageal diffuse mucosal candidiasis, rapid HIV antibody test was requested, which had a positive result. Then we performed Magnetic Resonance Imaging (MRI) with intravenous contrast showing a ring enhancement lesion in the right basal ganglia suggestive of brain toxoplasmosis. It was confirmed with significant raising of anti-toxoplasmosis IgG. Toxoplasma gondii infection is usually diagnosed by serologic tests. Although, brain imaging is necessary for proper diagnosis and management, its findings are not pathognomonic. Patients with toxoplasmic encephalitis typically experience rapid clinical and even radiologic improvement after initiation of appropriate therapy.