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AJNR - American Journal of Neuroradiology

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American Journal of Neuroradiology 25:270-273, February 2004
© 2004 American Society of Neuroradiology

Case Report
BRAIN

MR Imaging in Toxoplasmosis Encephalitis after Bone Marrow Transplantation: Paucity of Enhancement despite Fulminant Disease

Catalina Ionita^a, Mohammed Wasay^d, Lucia Balos^a and Rohit Bakshi^a,b,c

^a Department of Neurology and Pathology, University at Buffalo, SUNY, Buffalo, New York
^b Department of Kaleida Health, Imaging Services, New York
^c Department of Buffalo Neuroimaging Analysis Center, The Jacobs Neurological Institute, Buffalo, New York
^d Department of Neurology, the Aga Khan University , Karachi, Pakistan

Address correspondence to Rohit Bakshi, MD, Center for Neurological Imaging, Brigham & Women’s Hospital, Harvard Medical School, 221 Longwood Avenue, RF396, Boston, MA 02115

Summary: We present a patient who underwent bone marrow transplantation (BMT) after developing chronic myelocytic leukemia. Four months after BMT, he became comatose and died. MR imaging revealed multifocal brain lesions that were progressive but produced no edema. Postcontrast studies revealed that most of the lesions were nonenhancing. There was only discrete, irregular leptomeningeal enhancement with possible minimal enhancement of the cortex and subcortical white matter. Autopsy showed overwhelming toxoplasmosis encephalitis. This case illustrates that toxoplasmosis lesions may lack obvious contrast enhancement in the brain of the immunocompromised patients, despite severe involvement. Recognition of this unusual MR imaging manifestation of toxoplasmosis should lead to earlier diagnosis and treatment.