Cryptococcal meningitis and cerebral toxoplasmosis in a patient with acquired immunodeficiency syndrome.

A 34-year-old homosexual male developed cryptococcal meningitis as the initial manifestation of Acquired Immune Deficiency Syndrome (AIDS). With antifungal therapy he improved. Six weeks later he developed focal motor seizures and progressive hemiplegia. Computer assisted tomography revealed multiple, ring-enhancing, low density lesions. The patient expired and at necropsy he was found to have multiple toxoplasma brain abscesses as well as chronic cryptococcal meningitis. This case demonstrates that in a patient with AIDS with pre-existing central nervous system infection who develops new neurological symptoms the possibility of a second and potentially treatable infection must be considered and its diagnosis pursued vigorously.