Abstract：
Toxoplasma gondii is an opportunistic pathogen that can intrude into the blood-brain barrier and reside in the brain only with low inflammatory reaction. When infected with HIV, the immune system becomes severely compromised and leads to the reactivation of latent toxoplasmosis infection, which can mimic the clinical manifestation of stroke. We report a case of a 65-year-old female patient who presented with sudden right limb weakness, walking difficulty, and numbness without other typical symptoms, raising suspicion of acute ischemic stroke. The HIV serology returned positive, which expedited the diagnostic workup for opportunistic infection. Combining imageological examination and metagenomics next-generation sequencing of cerebrospinal fluid, HIV-associated cerebral toxoplasmosis was confirmed. The patient underwent treatment for toxoplasmosis and HIV. Six months after onset, the patient can walk independently but still exhibits weakness in the right upper limb. In HIV-infected patients, cerebral toxoplasmosis, particularly presenting as isolated stroke-like episodes, poses a more significant challenge, emphasizing the need for more thorough investigations to reduce the potential for misdiagnosis.
摘要：
弓形虫是一种机会性病原体，可以侵入血脑屏障并仅在低炎症反应的情况下驻留在大脑中。当感染艾滋病毒时，免疫系统严重受损，导致潜伏弓形虫感染的重新激活，可以模仿中风的临床表现。我们报告了一例65岁的女性患者，她突然出现右肢体无力，行走困难,没有其他典型症状的麻木，怀疑急性缺血性中风。HIV血清学结果呈阳性,这加快了机会性感染的诊断工作。结合影像学检查和宏基因组学对脑脊液进行下一代测序，HIV相关的脑弓形体病得到证实。患者接受了弓形虫病和HIV的治疗。发病六个月后，患者可以独立行走，但仍表现出右上肢无力。在HIV感染患者中，脑弓形虫病,特别是表现为孤立的中风样发作，构成了更重大的挑战，强调需要进行更彻底的调查，以减少误诊的可能性。
