Toxoplasmic Encephalitis Presenting as a Stroke Mimic in an AIDS Patient: A Case Report

TL;DR

This case report describes a patient with AIDS who presented with stroke-like symptoms but was diagnosed with toxoplasmic encephalitis, highlighting the importance of accurate diagnosis and interdisciplinary care.

Contribution

The case emphasizes the diagnostic challenge of TE mimicking stroke and the role of clinical pharmacists in guiding treatment for AIDS patients.

Findings

The patient's symptoms were initially mistaken for a stroke but were correctly identified as TE through comprehensive evaluation.

Interdisciplinary care, including clinical pharmacy input, was crucial for effective TE management.

Prompt diagnosis and treatment prevented unnecessary stroke interventions like alteplase.

Abstract

Toxoplasmic encephalitis (TE), a severe infection caused by Toxoplasma gondii, poses significant risks for immunocompromised patients, particularly those with HIV or AIDS. TE frequently manifests as focal encephalitis with confusion, headache, motor weakness, and fever, which may closely mimic ischemic stroke. These overlapping symptoms create diagnostic challenges, increasing the risk of misdiagnosis and treatment delays, both of which can lead to serious consequences in AIDS patients. This case report discusses the diagnosis and management of TE in a 45-year-old female with AIDS and multiple comorbidities who presented with acute left-sided weakness and facial droop, triggering a stroke alert. The patient, with a critically low CD4 count of 5 cells/μL and a history of toxoplasmosis and Pneumocystis jirovecii pneumonia, exhibited symptoms of left-sided weakness and facial droop. After prompt imaging and review of her extensive medical history, a clinical pharmacist suspected TE as the underlying cause rather than an ischemic stroke. This assessment was supported by her recent visit to an infectious disease specialist, who had treated her for TE the previous month.

This case highlights the critical role of comprehensive evaluations and accurate differential diagnoses by the medical team. Effective TE management depends on early recognition, timely diagnosis, and appropriate therapy initiation. This report underscores the importance of interdisciplinary care, particularly the role of clinical pharmacists in guiding treatment, addressing medication resistance, and promoting adherence to prevent opportunistic infections. In patients with psychosocial barriers to adherence, holistic approaches incorporating psychosocial support and close monitoring are essential for sustained care engagement. Prompt recognition and management of TE can reduce complications and prevent inappropriate interventions, such as unnecessary thrombolytic therapy (e.g., alteplase). By emphasizing early detection, thorough evaluation, and proactive care, healthcare providers can improve outcomes for TE in AIDS patients. This case illustrates the need for vigilance in identifying neurological symptoms and the value of coordinated care to address unmet medical and psychosocial needs in this vulnerable population.

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