This 38 y/o male presented with altered mental status and fever. There was no neck pain, stiffness, nor focal neurologic signs,WBC - 12,400 /mm³, lumbar puncture was non- specific. Selected images from a non-contrast enhanced CT and an MRI before and after contrast shown above demonstrate lesions in the basal ganglia bilaterally with extension into the left cerebral peduncle. There is some contrast enhancement after the administration of gadolinium. Subsequent investigations revealed the patient to be HIV positive. The diagnosis of cerebral toxoplasmosis was confirmed by stereotactic brain biopsy of the right basal ganglia.

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