Neurocysticercosis with Classic Ring Enhancing Lesions in a Patient with AIDS: Case Report, Diagnostic Approach and Literature Review
Main Article Content
Abstract
Introduction: Human immunodeficiency virus (HIV) is a neurotrophic, neuroinvasive, and neurovirulent pathogen, which can cause direct infection of the central nervous system (CNS) but also predisposes to a variety of other neuroinfections through impaired T-cell mediated immunity. Among the imaging findings in HIV patient with CNS infection, the presence of ring-enhancing intracranial lesions are considered not rare but quite puzzling diagnostic dilemma. The differential diagnosis for theses lesions commonly includes metastasis, abscess, glioblastoma, infarct, contusion, demyelinating disease, radiation necrosis, resolving hematoma or infections. Many features need to be considered altogether to help narrow the differential.
Case description: Male, 32 years old, with history of chronic smoking, pets: one cat dewormed and vaccinated, and positive diagnosis of HIV infection with a CD4 T lymphocyte count of 24 cells/mm3, without antiretroviral treatment. His main symptom was headache, associated with fever, nausea, and vomiting. Therefore, he was hospitalized for his diagnostic approach. Complete laboratory work was done, head CT, lumbar puncture, and MRI, finding rounded intra-axial lesions with well-defined and hyperintense edges in the parietal and occipital region with annular enhancement after the administration of contrast. After symptomatic treatment and anthelmintic therapy, a follow-up imaging study evidenced involution of these lesions. The patient met diagnostic criteria for definitive diagnosis of neurocysticercosis.
Conclusion: Even though, Neurocysticercosis is not a rare disease, our group decided to publish this case report because its asocciation with an HIV positive patient, in which has not been yet linked to, in behalf of the lack of evidence and studies, considering the ethical issue of performing rutinary head CT scans in asymptomatic individuals.
Article Details
This work is licensed under a Creative Commons Attribution 4.0 International License.
References
I. Sheybani, F., Van De Beek, D., & Brouwer, M. C. (2021). Suspected central nervous system infections in HIV-Infected adults. Frontiers in Neurology, 12.
II. Paruk, H., & Bhigjee, A. I. (2021). Review of the neurological aspects of HIV infection. Journal of the Neurological Sciences, 425, 117453.
III. The Joint United Nations Programme on HIV/AIDS (2023). World AIDS. Available from: https://www.unaids.org/sites/default/files/media_asset/UNAIDS_FactSheet_en.pdf
IV. Elsadway, M. E., & Ali, H. I. (2018). Verification of brain ring enhancing lesions by advanced MR techniques. Alexandria journal of medicine, 54(2), 167-171.
V. Tran, D. Q., Rahman, Q., Weed, M. R., & Chow, B. (2021). Differential diagnosis of a ring-enhancing brain lesion in the setting of metastatic cancer and a mycotic aneurysm. Radiology Case Reports, 16(12), 3850-3854.
VI. Knipe, H., & Gaillard, F. (2009). Cerebral ring enhancing lesions. [Accessed on 09 nov 2023] https://radiopaedia.org/articles/6679
VII. Vazquez, O. H., Romo, M. L., & Fleury, A. (2019). Neurocysticercosis and HIV infection: What can we learn from the published literature? Arquivos De Neuro-psiquiatria, 77(5), 357-365.
VIII. Bouteille, B. (2014). Epidemiology of cysticercosis and neurocysticercosis. Médecine et santé tropicales, 24(4), 367-374.
IX. Panel on Opportunistic Infections in HIV-Infected Adults and Adolescents (2018) Guidelines for the prevention and treatment of opportunistic infections in HIV-infected adults and adolescents: Recommendations from the Centers for Disease Control and Prevention, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America.
X. Castro-Vásquez, C., Maldonado, D. C., Arboleda, P. T. C., Camargo, M., Chavarro, O. J., Díaz, G. B., Buitrago, A. C., & Moutran, H. G. (2022). Caracterizando al enemigo: infecciones oportunistas en el sistema nervioso central en pacientes con VIH, una serie de casos colombiana. Neurología Argentina, 14(4), 215-220.
XI. Valle-Murillo MA, Amparo-Carrillo ME (2017). Infections of the central nervous system, part 1: Meningitis, Encephalitis and Brain abscess. Revista Mexicana de Neurociencia. 18(2):51-65
XII. Carpio, A., Fleury, A., Romo, M. L., & Abraham, R. (2018). Neurocysticercosis: The good, the bad, and the missing. Expert Review of Neurotherapeutics, 18(4), 289-301.
XIII. Bourlón-Cuellar R, Pérez-Páez I, Bourlón C, Mora-Arias T, Carrillo-Mezo R. Neurocisticercosis, diagnóstico y evolución por imagen. Presentación de un caso. Med Int Mex, 27 (6), 603-608.
XIV. Sarria-Estrada, S., Verzelli, L. F., Montilva, S. S., Acosta, C. A., & Cañellas, À. R. (2013). Neurocisticercosis. hallazgos radiológicos. Radiología, 55(2), 130-141.
XV. Haq, S. H., Shah, S., Bux, J., Le, A. S., Golzarian, H., Müller, D. J., Sreenan, J. J., Patel, S. M., Laird, A. M., & Cole, W. (2023). To intervene or not to intervene: A case of symptomatic neurocysticercosis complicated by ventriculitis. IDCases, 31, e01702.
XVI. García, H. H., González, A. E., & Gilman, R. H. (2020). Taenia solium cysticercosis and its impact in neurological disease. Clinical Microbiology Reviews, 33(3).
XVII. White AC Jr, Coyle CM, Rajshekhar V, et al. (2017). Diagnosis and treatment of neurocysticercosis: clinical practice guidelines by the Infectious Diseases Society of America (IDSA) and the American Society of Tropical Medicine and Hygiene (ASTMH). Clin Infect Dis 2018; 66(8):e49-e75
XVIII. Del Brutto, O. H., Nash, T. E., White, A. C., Rajshekhar, V., Wilkins, P. P., Singh, G., Vasquez, C. M. G., Salgado, P., Gilman, R. H., & Garcı́a, H. H. (2017). Revised diagnostic criteria for neurocysticercosis. Journal of the Neurological Sciences, 372, 202-210.
XIX. Zawadzki, R., Modzelewski, S., Naumowicz, M., Matyja, A., Urbaniak, A. D., Zajkowska, J., & Kubas, B. (2023). Evaluation of imaging methods in cerebral toxoplasmosis. Polish Journal of Radiology, 88(1), 389-398.
XX. Coyle, C. M. (2019). Neurocysticerosis. Infectious Disease Clinics of North America, 33(1), 153-168.
XXI. Jewell, P. D., Abraham, A., Schmidt, V., Buell, K. G., Bustos, J. A., Garcia, H. H., Winkler, A. S. (2021). Neurocysticercosis and HIV/AIDS co‐infection: A scoping review. Tropical Medicine & International Health.