Cerebral Toxoplasmosis: A Case Report with Correlation of Radiographic Imaging, Surgical Pathology, and Autopsy Findings

Abstract

Cerebral toxoplasmosis is an opportunistic infection of the central nervous system. Certain radiographic findings can be highly suggestive of the disease, but there is considerable overlap with both lymphoma and brain metastases, making the diagnosis difficult or delayed. Herein we present the case of a 77-year-old woman with a history of treated diffuse large B-cell lymphoma who presented with neurological symptoms four months after she was declared to be in remission. Her initial head computed tomography scan showed multiple low-attenuated lesions in her brain and a contrast enhanced magnetic resonance imaging scan showed multiple T1-and T2-enhancing lesions in the basal ganglia and at the gray-white junction. The clinical team was highly suspicious of a recurrence of her lymphoma so she had an extensive workup, including a brain biopsy, which did not lead to a definite diagnosis. After she died, an autopsy was performed, and multiple necrotic lesions were discovered in her brain. Histologic sections demonstrated numerous parasitic organisms, and immunohistochemical staining for Toxoplasma gondii was positive, confirming the diagnosis of cerebral toxoplasmosis. This case highlights an unusual case of cerebral toxoplasmosis that was diagnosed at autopsy and reviews the relevant radiographic findings as well as the gross and microscopic pathological features of the disease.

Blastic plasmacytoid dendritic cell neoplasm and cerebral toxoplasmosis: a case report

“…The brain lesions could represent cerebral toxoplasmosis due to their distribution and morphologic characteristics [14]. They were predominantly located at the basal ganglia, thalami and subcortically, which are common sites for toxoplasmosis (Fig.…”

Neuroimmunology of Common Parasitic Infections in Africa

“…In addition to an abundant leukocyte infiltration in the brain parenchyma, astrogliosis and microglial nodules are not unusual findings upon human cerebral toxoplasmosis ( 145 – 147 ). This is indicative of the implication of astrocyte and microglia responses in human TE.…”

Acrophialophora: A Comprehensive Review of Clinical Guidelines and Diagnosis

“…Toxoplasmosis brain abscesses appear as non-attenuated or low-attenuated lesions on a non-contrast CT [ 47 ]. On contrast-enhanced MRI, a target sign may be seen in abscesses; this presentation favors toxoplasmosis brain abscess over Acrophialophora infection as the cause of lesions [ 48 ]. T1-weighted (T1W) images may show a hypointense or isointense center surrounded by a hyperintense outer layer, while T2-weighted (T2W) images and fluid-attenuated inverted recovery (FLAIR) images show a hyperintense center surrounded by a hypointense region and another hyperintense outer edge [ 48 , 49 ].…”