Ring-enhancing brain lesions present a common radiological conundrum, especially in immunocompetent hosts where there is a broad differential diagnosis. Toxoplasma gondii, an obligate intracellular protozoan, typically causes encephalitis in immunocompromised patients, especially those with HIV/AIDS. Toxoplasma cerebral lesions in apparently immunocompetent people pose a diagnostic dilemma. The clinical features may mimic neoplastic or fungal causes, particularly when there are atypical radiological and histological presentations. We report an immunocompetent patient with toxoplasma encephalitis causing multiple cerebral lesions, with persistent clinical deterioration, ambiguous radiological findings and delayed response to treatment. The case emphasises the importance of tissue diagnosis and multidisciplinary management in this condition.
Bhandari et al. (Tue,) studied this question.