Magnetic Resonance Imaging Brain Image of a Patient with HIV-1 Infection and Cerebral Toxoplasmosis

The image on the cover represents the magnetic resonance imaging (MRI) of the brain of a 54-year-old HIV-1-positive male patient who presented with a short history of headache, altered sensorium, and seizures. He had a CD4 count of 123 cells per microliter and an HIV-1 viral load of 2,236,902 IU/ml. The MRI image shows a ring-enhancing lesion in the parasagittal region of the right frontal lobe with surrounding edema. There was a small eccentric nodule along the lesion wall called the eccentric target sign. This sign, when seen, is considered pathognomonic of toxoplasmosis with 95% specificity and 25% sensitivity. The eccentric nodule represents a leash of inflamed vessels entering into the lesion. The patient’s toxoplasma serology showed immunoglobulin G antibody levels >300 IU/ml allowing treatment to commence without a brain biopsy. He was started on sulfadiazine plus pyrimethamine plus leucovorin combination and showed a good clinical response within 2 weeks of initiation of therapy. An MRI obtained after 2 weeks of treatment showed regression of the lesion. It was decided to put him on highly active antiretroviral therapy (HAART) after 6 weeks of anti-toxoplasmosis therapy. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient’s guardian has given consent for images and other clinical information to be reported in the journal. The guardian understands that name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.