Misdiagnosis of HIV With Toxoplasmosis Encephalopathy With Progressive Memory Loss as the Initial Symptom: A Case Report

Abstract

Toxoplasmosis encephalopathy (TE) is a kind of encephalopathy parasitic disease caused by Toxoplasma gondii. It is the most common opportunistic for central system infection in patients with acquired immunodeficiency syndrome (AIDS) or human immunodeficiency virus. Without early diagnosis and proper treatment, this opportunistic infection can be life-threatening. The common clinical manifestations of the disease include altered mental state, epilepsy, cranial nerve damage, paresthesia, cerebellar signs, meningitis, motor disorders, and neuropsychiatry. The most common presentation in about 75% of cases is a subacute episode of focal neurological abnormalities such as hemiplegia, personality changes, or aphasia. Imaging needs to be differentiated from multiple sclerosis, lymphoma, and metastases. We report a case of acquired immune deficiency syndrome complicated with toxoplasma encephalopathy with rapid progressive memory loss as the initial symptom and misdiagnosed as multiple sclerosis. Through the comprehensive analysis of the clinical symptoms and imaging examination of this disease, we hope to enhance the confidence of clinicians in the diagnosis of this disease.

Advances and Challenges in Diagnostics of Toxoplasmosis in HIV-Infected Patients

“…It then binds to a co-receptor, most frequently either CCR5 (C-C chemokine receptor type 5) or CXCR4 (C-X-C chemokine receptor type 4) [ 29 ]. In the next step, HIV reverse transcriptase produces DNA from the virus RNA and HIV integrase inserts this DNA into the host cell genome [ 30 , 31 ]. Once transmitted, HIV takes hold in the mucous membranes and spreads to the lymphatic organs within a few days.…”

“…The decrease of CD4 + cell count below 200 cells/mm 3 results in severe dysfunction of the immune system, and then a diagnosis of AIDS is made. At this stage of the disease, untreated people usually develop opportunistic infections, such as toxoplasmosis [ 30 , 31 ]. Kodym et al [ 32 ] suggested that the reactivation of toxoplasmosis can occur in HIV and T. gondii co-infected subjects with not only the lowest CD4 + count but also with decreased number of CD8 + and NK cells.…”

“…Toxoplasmosis in HIV-positive patients is usually a consequence of the reactivation of parasite tissue cysts, leading to TE, headache, confusion, seizure, lethargy, and focal neurological symptoms [ 37 ]. TE is the most frequent clinical manifestation of toxoplasmosis in HIV-infected people [ 30 ]. In patients coinfected with HIV and toxoplasmosis, the risk of TE ranges from 30 to 40% [ 38 ].…”

“…Wu et al [ 30 ] emphasized that poorer cognitive function may accompany toxoplasma seropositivity. They noticed mild to moderate neurocognitive impairment in nearly half of HIV-infected people.…”

Cerebral Toxoplasmosis as an Uncommon Complication of Biologic Therapy for Rheumatoid Arthritis: Case Report and Review of the Literature

“…CNS toxoplasmosis occurs in about 30–40% of TG-seropositive patients with human immunodeficiency virus (HIV) infection [ 5 ], usually with acquired immunodeficiency syndrome (AIDS). In addition, it has also been reported in other immunocompromised states such as chemotherapy, solid organ or stem cell transplants and autoimmune diseases.…”