Cerebral Toxoplasmosis in an HIV-Positive 32-Year-Old Male with Poor Antiretroviral Therapy Compliance

Cerebral toxoplasmosis is a potentially fatal infectious disease of the central nervous system induced by reactivation of Toxoplasma gondii. It affects immunocompromised individuals specifically those with severe Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS) and CD4 T-lymphocyte counts < 100 cells/µL. Neuroimaging often reveals several ring-enhancing brain lesions, and the diagnosis is confirmed by serological tests and responsiveness to empiric treatment. Cerebral toxoplasmosis has a significant morbidity and mortality rate. In this case study, a patient with HIV who had CD4 < 100 cells/µL experienced fever, seizures, confusion, and focal neurological deficits. Cerebral toxoplasmosis was strongly suspected based on a magnetic resonance imaging (MRI) of the brain that showed multiple ring-enhancing lesions. Pyrimethamine, sulfadiazine, and folinic acid were used in the early stages of empirical therapy, in addition to corticosteroids to lessen cerebral edema and anticonvulsants to manage seizures. After acute therapy, trimethoprim-sulfamethoxazole was prescribed for secondary prevention, and antiretroviral therapy (ART) was initiated to restore immune function. This case emphasizes how important it is to identify and treat cerebral toxoplasmosis in immunocompromised patients as soon as possible, especially if they have an untreated HIV infection. It emphasizes the need for anti-toxoplasma therapy, ART and secondary prophylaxis for improved survival, and high suspicion for T. gondii reactivation.