HIV-2 infection with cerebral toxoplasmosis and lymphomatoid granulomatosis

A Nigerian man had acute onset of headache and vertigo due to a cerebellar mass. A brain biopsy of the mass revealed toxoplasmosis despite repeated ne gative HIV-1 serology. The presence of an opportunistic infection and his c ountry of origin raised the suspicion for HIV-2; this was confirmed by posi tive HIV-2 serology. Despite his preliminary pathological diagnosis, result s of physiological magnetic resonance imaging (MRI) (perfusion MRI and prot on magnetic resonance spectroscopy) were not typical for toxoplasmosis. The lesion showed a biochemical and perfusion pattern that was intermediate fo r infectious and neoplastic processes. Further neuropathology confirmed a s econdary diagnosis of lymphomatoid granulomatosis.