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Cerebral Toxoplasmosis - 1
Cerebral Toxoplasmosis - 1
doi: 10.1093/qjmed/hcw044
Advance Access Publication Date: 29 March 2016
Clinical picture
CLINICAL PICTURE
Cerebral toxoplasmosis
Figure 1. (A) Axial T2-weighed image revealing milimetric hypointense foci surrounded by a large vasogenic edematous area in right fronto-parietal white matter of
the brain. (B) Intacellular bradyzoides (arrows) of T. gondii in glial cells of the brain (Hematoxylin & Eosin staining, 40).
C The Author 2016. Published by Oxford University Press on behalf of the Association of Physicians.
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492 | QJM: An International Journal of Medicine, 2016, Vol. 109, No. 7
and/or radiologic improvement should raise the probability of Istanbul University, Istanbul, Turkey; S. Sahin and B. Oz,
an alternative diagnosis. Department of Pathology, Cerrahpasa Medical School Istanbul
A definitive diagnosis of cerebral toxoplasmosis requires University, Istanbul, Turkey. email: rozaras@yahoo.com
compatible clinical features including headache, neurological
symptoms, and fever, and identification of ring-enhancing
mass lesion(s) by brain imaging, and detection of the organism
in a biopsy specimen.2
References
In immunocompetent individuals, the probability of cerebral 1. Luft BJ, Remington JS. Toxoplasmic encephalitis in AIDS. Clin
toxoplasmosis is very low3 and a presumptive diagnosis of cere- Infect Dis 1992; 15:211.
bral toxoplasmosis may not be considered in a patient with a 2. Panel on Opportunistic Infections in HIV-Infected Adults and
focal cerebral lesion. For the presented case, a cerebral metasta- Adolescents. Guidelines for the prevention and treatment of
sis from urinary bladder cancer was not likely. The tumor was opportunistic infections in HIV-infected adults and adoles-
low-grade papillary and treated locally 3 years ago. The growth cents: Recommendations from the Centers for Disease Control
rate of these tumors is very slow and they rarely progress. The and Prevention, the National Institutes of Health, and the HIV