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Central nervous system vasculitis in a patient with HIV infection: a diagnostic challenge.

A 37-year-old woman with HIV infection (CD4: 5 cells/μl) presented with acute dysarthria and right hemiparesis. A brain CT showed nodular hyperdense lesions; MRI depicted cortico-subcortical hyperintense signals (Figure 1); MRI and CT angiography disclosed arterial stenosis suggesting vasculitis (Figure 2). The cerebrospinal fluid PCR confirmed cytomegalovirus infection. Highly-active antiretroviral therapy was started, but there was worsening of the symptoms, and she died one month later. Brain necropsy confirmed toxoplasmosis. CNS vasculitis in HIV patients may be caused by several infectious diseases1, such as CMV, toxoplasmosis, HIV virus, and others2. In this report we describe a HIV-infected patient with cerebral vasculitis related to co-infection.