Immunosuppression in Human Immunodeficiency Virus can
predispose to opportunistic infections of the central nervous system and can be
life threatening without early recognition and management. This can be delayed
in undiagnosed Human Immunodeficiency Virus. The present article is the only
case report in the literature to describe a first presentation of Acquired
Immune Deficiency Syndrome as cerebral Nocardia abscesses that were initially
treated as a stroke.
A previously well 59 year old Caucasian man presented
with sudden onset of left sided hemiparesis and sensory change, right sided
headache, diplopia and confusion. The patient was initially treated as a stroke
but was eventually found to have pulmonary and cerebral Nocardia abscesses
secondary to a new diagnosis of Human Immunodeficiency Virus/Acquired Immune
Deficiency Syndrome.
Human Immunodeficiency Virus infection can produce a variety
of neurological presentations with the added possibility of multiple pathological
processes being present simultaneously. This is only further complicated in
instances, such as the present case, when Human Immunodeficiency Virus
infection has not yet been diagnosed. It is therefore imperative that
appropriate neuroimaging is done at an early stage to ensure timely initiation
of appropriate therapy. Cerebral Nocardia abscesses are a serious and
potentially life threatening complication of Human Immunodeficiency Virus.
Below: Non-contrast Computed Tomography head. Non-contrast Computed Tomography head taken on admission showing scattered areas of hypodensity involving grey and white matter in the right basal ganglia, bilateral frontal lobes (see arrow) and bilateral parietal lobes
Below: Computed Tomography head with contrast. Computed Tomography head with contrast showing multiple ring enhancing lesions with surrounding oedema (see arrows)
Below: Diffusion Weighted Image-Magnetic Resonance Image. A Diffusion Weighted Magnetic Resonance Image showing multiple lesions with restricted diffusion (see arrows) consistent with multiple abscesses and developing hydrocephalus
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University of Cambridge School of Clinical Medicine, Cambridge, UK
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