Prepared by Roger Klein Moreira, MD, Resident, Stephen B. Hunter, MD, Associate Professor, and Frederick S. Nolte, PhD, Professor, Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Ga

A 48-year-old woman was admitted to the hospital with sudden-onset altered mental status, confusion, and mild headache. The physical examination and the history were unremarkable. During the hospital stay, the patient refused to be tested for HIV, but in an outpatient follow-up visit her CD4 cell count was found to be 12/µL. Magnetic resonance imaging (MRI) showed a 1.8-cm ring-enhancing lesion in the left temporal lobe (Figure 1). A brain biopsy showed extensive necrosis, perivascular inflammation (Figure 2), as well as many cysts measuring 10 to 40 µm that contained several round, nucleated structures (Figure 3).

What’s Your Diagnosis?
Cryptococcus infection

Toxoplasmosis

Histoplasmosis

Neurocysticercosis