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Intraparenchymal Hemorrhage due to Neurotoxoplasmosis as First Manifestation of HIV-AIDS

Nadia Mariel Rivera-Larraga*, Fernando Javier Pena-Gonzalez, Adrian Arguello-Pina, Luis Angel Gonzalez- Vergara

Background: Toxoplasmosis is defined as a parasitic zoonosis caused by the intracellular protozoan T. gondii which represents a significant public health problem in immunosuppressed patients, being this the most common opportunistic neuroinfection in those with HIV/AIDS. Its distinctive clinical presentation consists of cephalea, confusion, seizures, fever, photopsies and focal neurological signs, being its diagnosis achieved through compatible radiological images, positive serology, and a favorable response to empirical treatment. Toxoplasmosis brain lesions are usually a late complication that occurs in patients with AIDS CDC stage C3; it is exceptional that these and their consequences occur as the first manifestation of HIV/AIDS, which takes on special relevance given the physical and neuropsychological sequalae that it entails, as well as the reported mortality rate that can be as high as 20%.

Case report: This is the case of a 43 years old man with a history of diabetes mellitus type 2, systemic arterial hypertension, and testicular cancer in apparent remission, which was received in the emergency department of our hospital with symptoms compatible with a cerebrovascular accident, hyperthermia, and borderline oxygen saturation, in which intraparenchymal hemorrhage, pneumonia and neuroinfection were diagnosed. Also, a positive HIV (ELISA) serology, CD4 lymphocyte count for AIDS CDC stage 3 and positive PCR for toxoplasma in cerebrospinal fluid were determined in this patient. Thus, constituting an atypical presentation in which the diagnosis of HIV/ AIDS was achieved after a first manifestation of intraparenchymal hemorrhage due to toxoplasmosis.