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BMJ Case Reports 2013; doi:10.1136/bcr-2013-008803
  • CASE REPORT

Is it toxoplasma encephalitis, HIV encephalopathy or brain tuberculoma?

  1. Ahmed M Saliem4
  1. 1Cyberjaya University College of Medical Sciences, Cyberjaya, Malaysia
  2. 2Department of Parasitology, UKM, Bangi, Selangor, Malaysia
  3. 3Department of Pharmacology and Toxicology, Faculty of Medicine, Makkah, Saudi Arabia
  4. 4Department of Anatomy, Perdana University-Royal College of Surgeons in Ireland, Serdang, Selangor, Malaysia
  1. Correspondence to Dr Amal Rashad Nimir,aralmadi{at}yahoo.com

Summary

A 31-year-old Malaysian man was presented with an episode of seizures by the roadside, after having been recently diagnosed as HIV positive accompanied with miliary tuberculosis. On physical examination, he was oriented to person, but not to time or place. There was no neck stiffness or papilloedema. The other systemic examination was unremarkable. Chest examination revealed crepitations at the upper zone of the right lung. After diagnosis suspicion, the case was confirmed as toxoplasma encephalitis by MRI and serological tests. Patient was treated with trimethoprim/sulfamethoxazole 480–2400 mg/day with folinic acid supplement for 60 days. Two months later, a repeat brain MRI showed resolution of the cerebral lesions.

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