Intracranial Lesions in an HIV-Seropositive Person in a Resource-Limited Setting: A Case Report of Glioblastoma

Abstract

A bstract Persons living with human immunodeficiency virus (HIV) are susceptible to intracranial lesions. A 54-year-old woman with HIV presented with a 6-month history of severe headaches and left-sided weakness of 2 months. Her condition deteriorated with seizures, speech difficulties, and mood changes. She reported infrequent headaches in the last 6 years. At presentation, she had left hemiplegia, hypertonia, and hyperreflexia. Circulating HIV load was <40 copies/mL, CD 4 count; 902 cells∕mm 3 , Serum toxoplasmosis IgG was positive: 300 IU/L. Brain tissue histology showed refractile funv cocci of variable diameter and thick walls existing singly and in small chains with cystic cavities, granulomatous inflammation with areas of calcific changes, and inflammation suggestive of brain cryptococcoma. Magnetic resonance imaging suggested glioblastoma, cryptococcoma, and radiation necrosis. She failed to respond to liposomal amphotericin-B and high-dose cotrimoxazole, and serial imaging demonstrated progressive typical lesions, leading to definitive diagnosis of glioblastoma. Complexities of patient evaluation in resource-limited settings call for enhanced diagnostics for timely intervention.