Abstract

Cerebral toxoplasmosis is a severe condition often associated with HIV-positive patients. It can present as a neurological emergency, making early detection and prompt treatment crucial to preventing further neurological damage. We present a 34-year-old man, previously undiagnosed with HIV, who presented with worsening headaches, photophobia, dizziness, nausea, vomiting, and slurred speech. Neurological examination revealed left-sided central facial (VII) and hypoglossal (XII) nerve palsies. Laboratory tests confirmed HIV infection and elevated anti-toxoplasma antibodies. Imaging showed multiple ring-enhancing lesions, vasogenic edema, and a midline shift. The patient was treated with clindamycin, folic acid, citicoline, paracetamol, and dexamethasone. Symptoms improved within three days, with resolution of headaches and improvement in speech. Follow-up CT scans after 6 weeks showed reduced edema and lesion size. Cerebral toxoplasmosis as the initial manifestation of HIV is rare but critical finding. Early diagnosis and treatment are essential for improved outcomes, highlighting the need to consider cerebral toxoplasmosis as a potential early sign of HIV infection. This case demonstrates that clindamycin alone can be an effective treatment for cerebral toxoplasmosis, particularly in resource-poor settings or for patients with sulfonamide allergies.

Key words: cerebral toxoplasmosis, vasogenic edema, clindamycin, monotherapy, sulfonamide allergy