Cerebral toxoplasmosis

The patient was a 31 year old man with a history of intermittant confusion and disorientation. He carried the diagnosis of AIDS and had CD4 count of 100 per cubic milimeter. Differential diagnosis included cerebral toxoplasmosis, cytomegalovirus (CMV) encephalitis, primary CNS lymphoma, progressive multifocal leukoencephalopathy, fungal abcess due to Candida, Aspergillus, or Cryptococcus, Varicella-zoster virus encephalitis or vasculitis, Herpes simplex encephalitis, Tuberculosis (M. tuberculosis), and Kaposi's sarcoma.

MR images reveal several focal lesions involving basal ganglia, with some surrounding edema, and formation of cystic structures. CT demonstrates the calcification, and the "scalloped" ventricular wall can also be seen well with T1-weighted MR. The enlarged cisterna magna is an unrelated finding.

Some details have been altered to protect confidentiality.

Keith A. Johnson (keith@bwh.harvard.edu), J. Alex Becker (jabecker@mit.edu)