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Brain Mass; Toxoplasmosis infection versus lymphoma
Mar 17, 2002

Dear Dr. Dezube My cousin is a 42yr old male, HIV+ since Jan 01. At that time he had Lymphoma in the stomach area, CD4 cells 50, viral load 50,000, was treated with chemo and came out fine. In Oct 01 he had Toxoplasmosis, was also treated and came out ok. On Jan 20, 2002, he was found to have a brain mass. The doctors are not sure what this is, first they said this could be Toxoplasmosis infection or Lymphoma. He had 3 MRIs already and the most recent one shows the mass has grown more, he has been on Toxoplasmosis medication so we don't thing is Toxoplasmosis, we are very concerned that 2 months have passed since they found this, and they are still not sure of what this is, they are now considering a brain biopsy, but we dont know when. His current CD4 cells are 280 and viral load <400. He's on Viracept/3tc/Zerit. We see a decline on his movements, and has bad headaches. Is is reasonable for them to wait 2 months, and not even sure of what this is? any comments on what kind of brain mass this is?

Response from Dr. Dezube

A brain mass in an HIV-infected individual is always quite concerning. As you query indicates, the majority of these brain masses are either toxoplasmosis (an opportunistic infection) or lymphoma. Also as your query indicates, toxoplasmosis in your cousin's case is a bit unlikely given that the mass is growing despite toxoplasmosis therapy. Furthermore BOTH toxoplasmosis and lymphoma are unusual in a patient with a CD4 count of 280, though given that his CD4 count was 50 at one time, these diagnoses are possible. It is important to state that, on occasion, other diseases can cause brain masses. Although there are often clues to the diagnosis from the MRI scans, from spinal taps, and so on, the only definitive way of finding out what is going on is by doing a brain biopsy. Although the concept of a brain biopsy can sound overwhelming, a skilled neurosurgeon can typically perform such a procedure with little in the way of complications, by carefully biopsying the mass with a needle, rather than actually making an incision through the scalp. Once a diagnosis is made and your cousin gets treatment, he may do well. Please write back and let me know what he has. BD.

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