PMC6092451_01
A. Open ring-enhancement on brain MRI (left and right).B. Areas of necrosis with prominent perivascular lymphocytic cuffing. C. Free forms (Tachyzoite) (left) and cyst form (Bradyzoite) (right) of T. gondii organisms in a necrotic background (600x magnification). D. Relative mRNA expression by Syber green PCR of the tachyzoite surface marker SAG-1. E. Relative mRNA expression by Syber green PCR of the bradyzoite surface marker BAG-1 in the autopsy (brain tissue) of the patient.
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T2-weighted images and were of low signal on T1-weighted images. They showed surrounding edema, few areas of restricted diffusion peripherally, and a rim (open ring) of enhancement post gadolinium administration (Fig. 1A). On microscopic examination, large areas of necrosis with prominent perivascular lymphocytic cuffing were noted mainly within central white matter in the right cerebrum (frontal, parietal, and occipital) and left cerebrum (occipital, Fig. 1B). Toxoplasma gondii both as free forms (tachyzoites, Fig. 1C) and in cyst (bradyzoites, Fig. 1C). To further confirm the diagnosis, real-time PCR using primers recognizing the specific tachyzoite surface marker, surface antigen-1 (SAG-1) or the bradyzoite specific heat shock protein antigen-1 (BAG-1), confirmed the presence of both forms in the brain, underlying the reactivation of a cerebral toxoplasmosis (Fig. 1D and E respectively).