Nontuberculous mycobacteria mimicking cerebral toxoplasmosis in a human immunodeficiency virus-infected patient: a case report

Nontuberculous mycobacterial (NTM) central nervous system (CNS) infections are rare, with neuroimaging showing diffuse ring-enhancing lesions.In this case report, we describe a case of a human immunodeficiency virus (HIV)-infected patient who presented with a subacute onset of headache and altered mental status, with neuroimages highly suggestive of cerebral toxoplasmosis, but with no response to treatment, and later identification of a disseminated NTM infection.Presumptive diagnosis of an NTM CNS infection was based on extra-cerebral cultures and the favorable response to treatment.This report highlights the diagnostic challenge of intracerebral lesions in HIV-infected patients, especially when molecular testing and tissue sampling are unavailable.NTM infection of the CNS shall be considered in HIV patients presenting with lung, skin, or lymph node affection by NTM and altered mental status.