A 64-year-old woman with rapid neurologic decline diagnosed with Toxoplasma encephalitis after presumed metastatic cancer. (May 2021)

• Record Type: Journal Article
• Authors: Rosso, Claudia; Giscombe, Lisa; Tannous, Toufic; Keating, Matthew
• Is Part Of: SAGE open medical case reports. Volume 9(2021)
• Publication Date: 2021-05
• Subjects: Toxoplasmosis -- HIV -- anemia -- metastatic -- ring-enhancing lesion; Clinical medicine -- Case studies -- Periodicals; 616.09
• DOI: 10.1177/2050313X211019784
• Languages: English
• ISSNs: 2050-313X

Abstract

In an era of fragmented medical care, concurrent clinical features that ultimately lead to a unified diagnosis may not be prioritized appropriately. We present a case of a 64-year-old woman referred to hematology clinic for anemia, with recent memory loss and gait disturbance. Two months later, she developed pneumonia; imaging workup showed a left renal mass. Neurologic function continued to decline precluding definitive nephrectomy. She then presented with new-onset seizure and initial neuro-imaging was reported as unremarkable. One month later, outpatient neurologic workup demonstrated new left-sided weakness which prompted hospitalization and repeat neuro-imaging, which showed a 1.7-cm right frontal lobe mass lesion with surrounding vasogenic edema. The patient ultimately underwent craniotomy with resection of the mass lesion; pathology did not show metastatic renal cell cancer, the provisional clinical diagnosis. Rather, immunostaining revealed a parasite and ultimately led to a diagnosis of Toxoplasma encephalitis, an infection whose clinical presentation had been interpreted by healthcare providers for months to be a result of metastatic cancer.