CLINICAL INFORMATION

A 26-year-old Africa American male was diagnosed as HIV positive in 2007 without any treatment. In June 2009, he presented with cervical lymphadenopathy. Following admission, his CD4+ T-lymphocyte count was 26 /mm³ and serum HIV load was 280,000 copies/mm³. Computed tomography (CT) revealed enlargement of bilateral cervical and axillary lymph nodes, with the largest one measuring 2.2 cm. In addition, a 2.5 cm solid and cystic lesion was noted in the anterolateral basal ganglia of the brain by magnetic resonance imaging (MRI), mostly consistent with toxoplasmosis. No other lesions were noted on the skin or in the internal organs by physical examination and imaging studies. No pleural, pericardial or abdominal effusions were present. A cervical lymph node biopsy was performed. However, the patient declined brain and bone marrow biopsies. He was placed under highly active antiretroviral therapy (HAART), dexamethasone, pyrimethamine, sulfadiazine and leucovorin as treatment for HIV and the suspected toxoplasmosis. He had favorable responses to the treatment with significant decrease of viral load and improvement of the brain lesion. He remained stable 6 months after the initial treatment.

HE, 2×

HE, 4×

HE, 10×

HE, 20×

HE, 20×

HE, 40×

HE, 40×

HE, 40×

HE, 40×

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Source: Department of Pathology, University of Alabama at Birmingham

Photo: Zenggang Pan

Discussion: Zenggang Pan