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1. If ring-enhancing lesions are present, think toxoplasmosis (CNS lymphoma, TB, and bacterial infections less likely).

2. Because toxo is a reactivation infection, patients typically have IgG (but not IgM) antibody to T. Gondii. But this is only supportive as many have the IgG antibodies. Absence of antibodies does not exclude infection.

3. Treat with sulfadiazine, pyrimethamine, and leucovorin. Add dexamethasone if there is significant swelling.


1. Wilkinson, I. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press.
2. Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
3. Image: no reference available.

Ⓒ A. Manickam 2018

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