Central nervous system toxoplasmosis with atypical neurologic findings in an immunocompetent patient.

Abstract

Introduction: Central nervous system toxoplasmosis usually occurs in immunocompromised patients and is associated with severe clinical findings. It is rare in immunocompetent individuals.

Methods: A young patient presented with mild neurologic findings. Brain magnetic resonance imaging (MRI) with intravenous gadolinium contrast revealed a calcified lesion with mixed signal intensity in the cerebellum surrounded by mild edema and showing mild enhancement. Elevated immunoglobulin G and M titers for Toxoplasma gondii were found. A comprehensive diagnostic workup for other infectious, autoimmune, malignant, and immunosuppressive conditions yielded no clinically significant findings. Other common sites of toxoplasmosis involvement were excluded.

Results: Treatment with sulfamethoxazole-trimethoprim resulted in improvement of headaches and neurologic signs. At the 2-year follow-up, serial brain MRI scans showed no clinically significant changes apart from the absence of contrast enhancement. Clinically, the patient reports intermittent migraine-like headaches and a mild tremor in both upper limbs. No evidence of immunodeficiency was identified, supporting a final diagnosis of central nervous system toxoplasmosis in an immunocompetent patient.

Discussion: Central nervous system toxoplasmosis can occur in immunocompetent individuals, even with mild or atypical neurologic presentations. Brain MRI and serum serology are crucial for diagnosing these cases.