Snapshot A 29-year-old male is brought to the emergency department by his male partner due to chronic headache and confusion. The patient is HIV positive, and his CD4+ count one month ago was 73 cells/μL. He has not been adherent to his antiretroviral and prophylactic therapy. An MRI of the head is shown. Enzyme linked immunoassay (ELISA) shows positive anti-toxoplasma IgG antibodies. Introduction Most common infection of the central nervous system in patients with AIDS Caused by Toxoplasma gondii login to view 1 more bullet Infection in immunocompetent login to view 1 more bullet Infection in immunosuppressed (e.g., AIDS) login to view 5 more bullets Extracerebral manifestations of toxoplasmosis login to view 2 more bullets Epidemiology 30% risk of reactivation in immunocompromised (especially CD4+ count < 100 cells/μL) login to view 1 more bullet ~ 30% of the worldwide population is infected Presentation Symptoms login to view 6 more bullets Physical symptoms login to view 1 more bullet Evaluation Head imaging login to view 3 more bullets Serology login to view 1 more bullet Differential Brain abscess CNS lymphoma Metastatic cancer Neurocysticercosis Treatment Medical login to view 6 more bullets Special considerations login to view 4 more bullets Prevention, Prognosis, and Complications Prevention login to view 8 more bullets Prognosis login to view 2 more bullets Complications login to view 2 more bullets