Approach to an hiv patient with intracranial mass lesion

Neurological signs and symptoms are one of the commonest complaint of patients living with HIV (PLWHA). In these patients, radiological evaluation using computed tomography (CT) or magnetic resonance imaging (MRI) often reveal an intracranial mass lesion, which often presents as a diagnostic and therapeutic challenge for clinicians. Although there is no epidemiological data on the rate of misdiagnosis and/or mistreatment of PLWHAs presenting with CNS symptoms, numerous case reports find that distinguishing between different etiologies of CNS symptoms in PLWHAs is often difficult. A 42-year-old female with known HIV status presented to the ER with headache for 2 weeks before admission and left-sided hemiparesis and cranial nerve neuropathy, with intact consciousness. Her head CT revealed multiple contrast-enhancing lesions with meningeal enhancement, features commonly found in either toxoplasmic encephalitis (TE), primary central nervous system lymphoma (PCNSL), progressive multiple leukoencephalopathy (PML), or tuberculous (TB) meningitis. Based on her positive toxoplasma serology, she was treated empirically with anti-toxoplasmosis regimens, and her symptoms improved. An approach based on symptomatic presentation (diffuse or focal), neuroepidemiology, and status of immunosuppression is advised. Physicians are encouraged to use diagnostic algorithms to treat these patients.