Seizure as an Initial Presentation of Human Immunodeficiency Virus: Acute Toxoplasmosis Mimicking Glioblastoma Multiforme

We present a case of a 46-year-old man with a history significant only for hypertension and depression that presented with a new onset seizure resulting from a right parietal lobe mass. Further evaluation determined the parietal mass to be central nervous system toxoplasmosis, which was the initial presentation of his underlying HIV/AIDS. This case provided a diagnostic challenge and demonstrates the importance of a thorough evaluation as it pertains to a newly diagnosed brain lesion.

Background

Seizures are a relatively common initial manifestation of a space-occupying brain lesion. The differential diagnoses of a new onset seizure are vast and therefore it is essential for the clinician to perform a thorough evaluation. CT and MRI are often the initial diagnostic tests used in the setting of a new onset seizure to evaluate for any space occupying lesions. If present, the characteristics of the lesion seen on imaging may be suggestive of a neoplastic or infectious aetiology, however as this case demonstrates, should not preclude further exploration of other causes.

Case presentation

A 46-year-old man, with a medical history significant only for hypertension and depression, presented to an outside hospital with a witnessed episode of a new onset seizure. As per family accounts, he was performing yard work for the greater portion of the day in extreme heat after which he came home and sat down at the dinner table of hunger and dehydration when the episode ensued. The family described the episode as echolalia followed by 3–5 min of generalised tonic–clonic activity. Once the seizure had subsided, the patient was unaware of his surroundings and unable to recognise his family members for 20–30 min. Emergency medical services were called and the patient arrived to the emergency department (ED) through ambulance no longer in a postictal state.

Differential diagnosis

• Primary brain neoplasm (glioblastoma multiforme)
• Central nervous system (CNS) lymphoma
• Bacterial or fungal abscess
• CNS toxoplasmosis

Full article at:  http://goo.gl/db1zfS

By:  Parth Parekh,1 Jody P Boggs,1 Marc Silverberg,2 and Paul Marik3

¹Department of, Internal Medicine, Eastern Virginia Medical School, Norfolk, Virginia, USA

²Department of Pathology, Sentara Norfolk General Hospital, Norfolk, Virginia, USA

³Division of Pulmonary and Critical Care Medicine, Eastern Virginia Medical School, Norfolk, Virginia, USA

Correspondence to Dr Paul Ellis Marik, Email: ude.smve@epkiram

 

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