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已发表论文
艾滋病患者颅内巨大病变：脑肿瘤与弓形虫脑炎的诊断难题通过经验性治疗得以解决
Received 12 July 2025
Accepted for publication 27 November 2025
Published 3 December 2025 Volume 2025:18 Pages 1527—1532
DOI https://doi.org/10.2147/IMCRJ.S553371
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 2
Editor who approved publication: Dr Gates Colbert
Lun Zou, Yuting Diao, Chunfang You
Department of Infectious Diseases, Zigong First People’s Hospital, Zigong, Sichuan, People’s Republic of China
Correspondence: Chunfang You, Department of Infectious Diseases, Zigong First People’s Hospital, No. 42, Shangyihao Branch Road 1, Zigong, Sichuan, 643000, People’s Republic of China, Email 2421662719@qq.com
Background: Human immunodeficiency virus (HIV)-associated cerebral toxoplasmosis is the most frequent cause of ring-enhancing brain lesions in acquired immune deficiency syndrome (AIDS) patients but is often misdiagnosed as neoplasm due to overlapping clinical and radiological features. Seronegative examinations further complicate diagnosis, risking fatal delays in treatment.
Case Presentation: A 32-year-old male with undiagnosed HIV presented with right hemiparesis, dysarthria, and headache. Magnetic resonance imaging (MRI) revealed a 38× 54 mm ring-enhancing left frontoparietal mass with significant edema, midline shift, and ventricular compression, initially suggestive of glioblastoma. HIV serology confirmed infection. Toxoplasma antibodies, nucleic acid test and next-generation sequencing were all negative. Despite 17 days of antiretroviral therapy and sulfamethoxazole-trimethoprim prophylaxis, he deteriorated to coma with lesion progression on repeat MRI. Empirical anti-toxoplasma therapy was initiated. Within one week, consciousness and speech improved. At 6 weeks, MRI showed reduced lesion size and edema, and right limb strength partially recovered, enabling discharge.
Conclusion: This case illustrated that seronegative Toxoplasmic encephalitis may mimic aggressive neoplasms radiologically and clinically in advanced AIDS. Empirical anti-toxoplasma therapy should be considered a prioritized intervention over invasive diagnostics for ring-enhancing lesions in severely immunocompromised patients, particularly when brain biopsy is high-risk or contraindicated, even in seronegative cases.
Keywords: HIV/AIDS, intracranial lesion, magnetic resonance imaging, toxoplasmic encephalitis, treatment
Department of Infectious Diseases, Zigong First People’s Hospital, Zigong, Sichuan, People’s Republic of China
Correspondence: Chunfang You, Department of Infectious Diseases, Zigong First People’s Hospital, No. 42, Shangyihao Branch Road 1, Zigong, Sichuan, 643000, People’s Republic of China, Email 2421662719@qq.com
Background: Human immunodeficiency virus (HIV)-associated cerebral toxoplasmosis is the most frequent cause of ring-enhancing brain lesions in acquired immune deficiency syndrome (AIDS) patients but is often misdiagnosed as neoplasm due to overlapping clinical and radiological features. Seronegative examinations further complicate diagnosis, risking fatal delays in treatment.
Case Presentation: A 32-year-old male with undiagnosed HIV presented with right hemiparesis, dysarthria, and headache. Magnetic resonance imaging (MRI) revealed a 38× 54 mm ring-enhancing left frontoparietal mass with significant edema, midline shift, and ventricular compression, initially suggestive of glioblastoma. HIV serology confirmed infection. Toxoplasma antibodies, nucleic acid test and next-generation sequencing were all negative. Despite 17 days of antiretroviral therapy and sulfamethoxazole-trimethoprim prophylaxis, he deteriorated to coma with lesion progression on repeat MRI. Empirical anti-toxoplasma therapy was initiated. Within one week, consciousness and speech improved. At 6 weeks, MRI showed reduced lesion size and edema, and right limb strength partially recovered, enabling discharge.
Conclusion: This case illustrated that seronegative Toxoplasmic encephalitis may mimic aggressive neoplasms radiologically and clinically in advanced AIDS. Empirical anti-toxoplasma therapy should be considered a prioritized intervention over invasive diagnostics for ring-enhancing lesions in severely immunocompromised patients, particularly when brain biopsy is high-risk or contraindicated, even in seronegative cases.
Keywords: HIV/AIDS, intracranial lesion, magnetic resonance imaging, toxoplasmic encephalitis, treatment