Cerebral toxoplasmosis mimicking intracranial tuberculoma

Focal neurological disease in patients with acquired immunodeficiency syndrome may be caused by various opportunistic infections and tumours. It was recognized early in the HIV epidemic, that the diagnosis of the focal CNS lesions would be difficult. A 21-year old female, known case of a retroviral disease, presented to our institute with complaints of fever, headache and vomiting. A computed tomography scan of her brain showed a single ring enhancing lesion in the left basal ganglia. Toxoplasma serology revealed raised IgG antibody levels. Based on the CT features and the positive toxoplasma serology, a diagnosis of cerebral toxoplasmosis was made. She was treated with trimethoprim/sulfamethoxazole and pyrimethamine/ sulfadoxine. The patient was symptomatically better after 72 hours. After 21 days, a repeat CT of brain was done, which showed significant resolution of the lesions. Cerebral toxoplasmosis is still the commonest cerebral opportunistic infection in HIV-infected patients.