Case of the Month: March 2026
Case history
- 25-year-old patient presented with reduced level of consciousness and headache.
Click to reveal diagnosis
- CT and MRI showed multiple peripherally enhancing lesions with surrounding vasogenic oedema without diffusion restriction.
- A new diagnosis of HIV was made with a CD4 count of less than 5. PCR was positive for T. Cruzi.
- The combination of ring-enhancing lesions without diffusion restriction in a severely immunocompromised patient raised the differential of toxoplasmosis, CNS lymphoma, and — in the context of positive T. Cruzi PCR — cerebral Chagas disease.
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Chagas disease (American trypanosomiasis) rarely involves the CNS except in the setting of severe immunosuppression, where reactivation can produce a tumour-like chagoma or meningoencephalitis.