Toxoplasmic ventriculitis with obstructive hydrocephalus in patient with AIDS: Case report with review of literature

Toxoplasmosis is a common opportunistic infection in immunocompromised patients. Cerebral toxoplasmosis can be the initial manifestation of acquired immunodeficiency syndrome (AIDS). We report a case diagnosed at autopsy as the primary presentation of an undiagnosed human immunodeficiency virus (HIV)-positive patient. Histological examination revealed a prominent rim of periventricular necrosis involving the frontal, temporal, and occipital horns of the lateral ventricle, third and fourth ventricle. The ependymal lining was denuded with numerous encysted bradyzoites and scattered tachyzoites of Toxoplasma dispersed in the necro-inflammatory areas. Hydrocephalus due to cerebral toxoplasmic ventriculitis is very rare in adults. Mortality was significantly higher in cases with ventriculitis as compared to patients with only hydrocephalus due to mass lesions. Choroid plexus involvement in toxoplasmic ventriculitis could indicate a hematogenous spread from reactivation of latent systemic infection rather than reactivation of latent brain lesion. This case report emphasizes the importance of evaluation of HIV status in the presence of complex periventricular enhancement and the importance of a high degree of clinical suspicion for toxoplasmic ventriculitis in HIV patients with hydrocephalus, as an early institution of empirical anti-toxoplasma treatment could play a crucial role in cure.