Introduction: The most common opportunistic infection and cause of CNS infection in untreated acquired immunodeficiency syndrome (AIDS) patients is Toxoplasma Encephalitis caused by the parasite Toxoplasma gondii. Toxoplasmosis usually causes infection in AIDS patients (defined as CD4 <200 cells/microL) when CD4 counts drop below 100 cell/microL and reactivation when the CD4 counts fall below 200 cells/μl. Whether a primary infection or reactivation, immunocompromised persons present with serious symptoms such as headache, confusion, seizures, and blurred vision which can indicate necrotizing encephalitis. Without treatment, patients progress to coma in days to weeks, significantly increasing morbidity and mortality.

Case Report: We present a 52-year old African American female who presented with a two-day history of chest pain, productive cough and shortness of breath. She has a past medical history of recurrent Pneumocystis Jiroveci pneumonia, HIV, and a 4 year history of non-compliance with anti-retroviral therapy. Her last CD4 count, measured 132 cells/mm3 four weeks prior to admission. Within 24 hours of admission, the patient developed two seizures, became comatose, and was admitted to the intensive care unit. Imaging studies of the head and brain showed a 3.7x3.9 cm solid cystic mass in the left parietotemporal lobe and an accompanying subarachnoid hemorrhage. The patient was started on Trimethoprim-Sulfamethoxazole (TMP-SMX) for a possible diagnosis of toxoplasmosis. The following day, the patient had multiple bradycardic episodes possibly due to spontaneous breathing trial attempts, but was still unresponsive. The family was consulted on the patient’s status, and they decided that aggressive therapy be stopped for the patient. Unfortunately, the patient expired the following day.

Conclusion: This case highlights the different treatments of toxoplasmosis in AIDS patient according to the standard of care, as well as overlapping CNS complications that can be fatal. Thus, highlighting the importance of early detection and prevention in the immunocompromised individuals.

Keywords: Acquired immunodeficiency syndrome, Encephalitis, Highly active antiretroviral therapy, Toxoplasmosis