Case history and clinical manifestations

It is a case of AIDS definitely diagnosed by CDC, a male aged 53 years, who had history of paid blood donation in the year of 1992. The definite diagnosis was made in Feb. 2003 and he fell ill in Feb. 2004 with symptoms of fever, headache, and asthenia of the right extremities, rigidity, motion inconvenience and speaking dullness. CD4 count was 25 cells/µl.

Fig. 2-3-1 A Axial MR imaging demonstrating intracephalic multiple flaky high T2 signals, obvious abscesses and no obvious space-occupying effect.

Fig. 2-3-1 B Axial MR imaging demonstrating obvious multiple abnormal enhancements in nodular, curved rod and rarely ring shapes and thickened left occipital meninges.

Diagnosis

AIDS complicated cerebral trichinization.

Discussion

Intracephalic foci of this case frequently occur in the junctures of cortex and medulla with occasional distributions in deep parts of brain, which is the point for its differentiation from cerebral toxoplasmosis and neoplasms. AIDS complicating cerebral trichinization is characteristically regional, which occurs in the cases of decreased immunity. CT scanning and MR imaging are highly sensitive to intracephalic lesions. The enhanced MR imaging has demonstrations of curved rod shaped, ring shaped and nodular shaped abnormal enhancements. Case reports of AIDS complicating cerebral trichinization are rare and its knowledge is limited, which is the main reason for its misdiagnosis. AIDS complicating intracephalic trichinization should be imageologically differentiated from other AIDS complications, such as tuberculous cerebral abscess, toxoplasmosis cerebral abscess and cerebral lymphoma. Diagnosis can be accurately made based on combination of imaging manifestations and laboratory tests and its qualitative diagnosis needs further evidence from histopathological or immunohistochemical examinations.

Fig. 2-3-1 A Fig. 2-3-1 B