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Infectious Diseases
Coinfection of cerebral toxoplasmosis and neurosyphilis as the first manifestation of AIDS
  1. Emily Duffus1,
  2. Sree Chinta2,
  3. Pooja Patel3 and
  4. Diana G Finkel4
  1. 1Internal Medicine/Pediatrics, Rutgers New Jersey Medical School, Newark, New Jersey, USA
  2. 2Internal Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, USA
  3. 3Neurology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
  4. 4Department of Medicine, Division of Infectious Disease, Rutgers New Jersey Medical School, Newark, New Jersey, USA
  1. Correspondence to Dr Diana G Finkel; finkeldi{at}njms.rutgers.edu

Abstract

A male in his 30s with a medical history of newly diagnosed HIV with a CD4 count of 292 cells/mm3 presented with a bilateral frontal headache and left upper and lower extremity weakness and paraesthesias. A few months prior, the patient experienced a desquamating rash on his scalp and a pruritic, papular genital rash, which both self-resolved. CT head without contrast revealed extensive vasogenic oedema involving the right basal ganglia, thalamus, temporal and occipital lobes. MRI of the brain with and without contrast revealed two enhancing masses in the right lentiform nucleus and right temporal-occipital junction with associated vasogenic oedema. Cerebrospinal fluid (CSF) studies confirmed cerebral toxoplasmosis with positive CSF Toxoplasma gondii PCR and neurosyphilis with positive serum rapid plasma reagin and CSF venereal disease research laboratory test. He was treated with trimethoprim/sulfamethoxazole and intravenous penicillin G with the resolution of his symptoms.

  • HIV / AIDS
  • Infection (neurology)
  • Neuroimaging
  • Public health
  • Radiology

https://doi.org/10.1136/bcr-2024-261502

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    Footnotes

    • X @poojaapatel7

    • Contributors The following authors were responsible for drafting of the text, sourcing and editing of clinical images, investigation results, drawing original diagrams and algorithms and critical revision for important intellectual content: ED, SC, PP and DGF. The following authors gave final approval of the manuscript: ED, SC, PP and DGF.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.