title: Multiple intracranial space-occupying lesions in a renal transplant recipient from an area endemic for tuberculosis (TB): TB vs. toxoplasmosis.
abstract: Renal transplant recipients may present with intracranial space-occupying lesions (SOLs) due to infections as well as a post-transplant lymphoproliferative disorder (PTLD). Here, we discuss a renal transplant recipient who presented with neurologic symptoms and magnetic resonance imaging (MRI) of the brain showed multiple focal SOLs. Tuberculosis (TB), toxoplasmosis, nocardiosis, fungal infections, and PTLD were considered in the differential diagnosis. MRI spectroscopy was suggestive of an infectious cause, such as toxoplasmosis or TB. Serologic tests using Toxoplasma were negative. A brain biopsy followed by immunohistochemical staining using Toxoplasma antibody demonstrated multiple intravascular cysts of toxoplasma. This case highlights the diagnostic dilemma in an immunocompromised patient with multiple focal brain lesions, especially in areas where TB is endemic.
authors.affiliation: Department of Nephrology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: S
authors.initials: S
authors.lastname: Bagchi
authors.forename: S S
authors.initials: SS
authors.lastname: Sachdev
authors.forename: A
authors.initials: A
authors.lastname: Nalwa
authors.forename: C J
authors.initials: CJ
authors.lastname: Das
authors.forename: S
authors.initials: S
authors.lastname: Sinha
authors.forename: V
authors.initials: V
authors.lastname: Suri
authors.forename: S
authors.initials: S
authors.lastname: Mahajan
authors.forename: D
authors.initials: D
authors.lastname: Bhowmik
authors.forename: S
authors.initials: S
authors.lastname: Agarwal
mesh_terms: D000328:Adult; D020314:Central Nervous System Fungal Infections / Q000175:diagnosis; D003937:Diagnosis, Differential; D006801:Humans; D007194:India; D016030:Kidney Transplantation / Q000009:adverse effects*; D008232:Lymphoproliferative Disorders / Q000175:diagnosis / Q000209:etiology; D008279:Magnetic Resonance Imaging; D008297:Male; D009617:Nocardia Infections / Q000175:diagnosis; D016781:Toxoplasmosis, Cerebral / Q000175:diagnosis* / Q000188:drug therapy; D016862:Tuberculoma, Intracranial / Q000175:diagnosis*
keywords: toxoplasmosis; transplant; tuberculosis