Case Report: Calcified Cerebral Toxoplasmosis Associated with Perilesional Edema in People Living with HIV/AIDS: Case Series of a Presentation Mimicking Neurocysticercosis

Abstract

Perilesional edema, associated or not with neurological manifestations, is a well-characterized finding in cases of calcified neurocysticercosis. There are no previous reports of HIV-related calcified toxoplasmosis that mimics this presentation of neurocysticercosis. We report on five patients, four of them with new-onset neurological manifestations, who showed brain calcifications associated with perilesional edema. All cases had a history of HIV-related toxoplasmosis and current virological and immunological control of HIV infection. Similar to neurocysticercosis, brain calcified toxoplasmosis may cause perilesional edema and symptoms in people living with HIV/AIDS.

Calcified cerebral toxoplasmosis associated with recurrent perilesional edema causing neurological manifestations in an HIV-infected individual: case report with a decade-long follow-up

“…Currently, it is still unclear whether peri-calcification edema observed in patients with seizures result from an immunological mechanism (recognition of parasite antigens in the calcified matrix) or whether edema is secondary to seizure-induced blood-brain barrier disruption. The persistent contrast enhancement in the periphery of some calcified lesions, the peri-calcification edema in certain patients without seizures, and the chronology of the clinical-radiological findings observed in some cases, suggest an immunological origin 9 . This rationale has been proposed for neurocysticercosis, but a similar mechanism is likely in cerebral toxoplasmosis.…”

“…We report the case of a PLWHA with cerebral calcification corresponding to prior cerebral toxoplasmosis associated with recurrent perilesional edema and neurological manifestations. Previously, only four PLWHA with calcified cerebral toxoplasmosis associated with a single episode of perilesional edema causing neurological manifestations were described 9 .…”

“…The calcified neurocysticercosis lesions are typically small, rounded, well-defined calcified nodules less than 1 cm in diameter. On the other hand, calcified cerebral toxoplasmosis commonly presents a spectrum of dot-like, or thick and “chunky,” or “brain stone” lesions 9 .…”

“…There is no explanation for the fact that only some calcified lesions in neurocysticercosis are associated with edema and that only some of them cause seizure activity or other clinical manifestations 19 . We recently reported a series of four cases of HIV-related toxoplasmosis with current virological and immunological control of HIV infection, which presented perilesional edema around their cerebral calcifications 9 , suggesting that calcified cerebral toxoplasmosis may cause perilesional edema and symptoms in PLWHA, similar to neurocysticercosis.…”

“…In this scenario, there is little information on the long-term evolution of treated cerebral toxoplasmosis, including residual calcified brain lesions. Recently, four PLWHA with calcified cerebral toxoplasmosis and a single episode of perilesional edema associated with neurological manifestations were described 9 . Prior to this, calcified brain lesions associated with perilesional edema and neurological manifestations were described in individuals with neurocysticercosis, usually immunocompetent 10 , 11 .…”