title: High-intensity signals in the basal ganglia from gadolinium-enhanced T1-weighted MRI as an early change in toxoplasma encephalitis in an AIDS patient.
abstract: A 30-year-old Brazilian man hospitalized with AIDS developed a high-grade fever. Neither culture studies nor radiological examinations revealed the cause; small yet highly intense signals in the basal ganglia were detected upon gadolinium (Gd)-enhanced T1-weighted magnetic resonance imaging (MRI) of the head. This finding was equivocal at that time but obviously abnormal for his age. A week later, he developed a movement disorder in his right arm, speech apraxia, and a worsening disturbance of consciousness. Repeated Gd-enhanced T1-weighted MRI demonstrated incredible changes in the brain; enhanced lesions in the basal ganglia deteriorated over time, multiple nodular and ring-enhanced lesions were observed in almost the entire brain. A diagnosis of toxoplasma encephalitis (TE) was confirmed by the detection of Toxoplasma gondii DNA in the cerebrospinal fluid. After initiation of intravenous trimethoprim-sulfamethoxazole (TMP-SMX; 10 mg/kg/day of TMP and 50 mg/kg/day of SMX) treatment, his symptoms and radiological findings improved dramatically. Our case suggests that high-intensity signals seen in the basal ganglia of a Gd-enhanced T1-weighted MRI, even at the preclinical stage, is indicative of TE. Because the use of MRI in general has become more widespread, it is predicted that preclinical lesions of TE will be found in various clinical settings more frequently.
authors.affiliation: Department of Hematology and Oncology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan.
authors.forename: Kei
authors.initials: K
authors.lastname: Suzuki
authors.forename: Masahiro
authors.initials: M
authors.lastname: Masuya
authors.forename: Takeshi
authors.initials: T
authors.lastname: Matsumoto
authors.forename: Naomi
authors.initials: N
authors.lastname: Ito
authors.forename: Kohshi
authors.initials: K
authors.lastname: Ohishi
authors.forename: Masayuki
authors.initials: M
authors.lastname: Maeda
authors.forename: Naoyuki
authors.initials: N
authors.lastname: Katayama
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology; D000163:Acquired Immunodeficiency Syndrome / Q000469:parasitology; D000328:Adult; D001479:Basal Ganglia / Q000469:parasitology* / Q000473:pathology; D001921:Brain / Q000469:parasitology / Q000473:pathology; D003287:Contrast Media; D004660:Encephalitis / Q000188:drug therapy / Q000469:parasitology* / Q000473:pathology / Q000821:virology; D005682:Gadolinium; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D014122:Toxoplasma / Q000302:isolation & purification*; D016781:Toxoplasmosis, Cerebral / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology / Q000821:virology
chemical_list: D003287:Contrast Media; D005682:Gadolinium