Unilateral Papilledema as a Rare Manifestation of Cerebral Neurotoxoplasmosis in HIV Patient: Case Report

Abstract

Introduction: Cerebral toxoplasmosis is one of the opportunistic diseases that present in patients with HIV/AIDS. One of the rare symptoms is unilateral papilledema due to cerebral toxoplasmosis. Case report: A 26-year-old male patient came with complaints blurred vision for 2 months. The patient had a history of pouting lips, and weakness face, arm, and legs on the left side of the body. The patient has been diagnosed with the observation of space occupying lesion Cerebri in November 2020. Patient with HIV stage IV (WHO) infection and CD4 14 cells/uL and viral load 5.43 x 105 copies /mL. Visual acuity left eye 6/18 PH 6/12, contrast sensitivity examination in both eyes 1.65, and the results of FD-15 are within normal limits, but the results of perimetry was enlargement of blind spot, relative afferent pupillary defect in the left eye, with optic nerve head swelling in the left eye. An MRI showed the presence of intracerebral neurotoxoplasmosis. Discussion: Papilledema is the manifestation of optic nerve abnormality due to an increase in intracranial pressure. Cerebral toxoplasmosis leads to asymmetric target lesion present with ring enhancement image on MRI with contrast which causes SOL and manifests as papilledema. Bilateral papilledema is a hallmark of increasing cerebrospinal fluid pressure, but unilateral papilledema is a rare case with a 2% of prevalence among papilledema cases. Two proposed mechanisms of atypical papilledema were anatomical nerve sheath anomalies and unilateral axoplasmic blockage of the lamina cribrosa. Conclusion: Early diagnosis and appropriate treatment have a very important role in determining the prognosis of patients with cerebral toxoplasmosis.