Malaria is endemic in tropical and subtropical regions, but may occur worldwide. Cerebral malaria develops several weeks after mosquito bites infect the host with Plasmodium falciparum. The encephalopathy is often


Cerebral toxoplasma granulomas. A 62-year-old HIV-positive man presented with a several-week history of generalized weakness, headaches, vomiting, confusion, and disorientation. A. CT scan of the head shows a large left frontal hypodense, nonenhancing lesion with mass effect. Despite a negative biopsy, the patient was treated for toxoplasmosis. B. CT scan 1 month later shows resolution of the lesion. After a 6-month clinical course, he died of numerous medical complications. C. Horizontal section of the brain shows the biopsy scar in the left caudate and a recent large toxoplasma granuloma in the right thalamus (D) extending into the brainstem. E. The granuloma shows coagulative necrosis, diffuse lymphocytic infiltrations, and (F) loose nodules of microglial cells and lymphocytes (HE).

* /ll1 * • * i fulminant; it results from obstruction of microcirculation by infected and sequestrated red blood cells, subsequent endothelial damage, and pericapillary ring hemorrhages and small infarcts. Malaria granulomas (Dürck nodules) are clusters of microglial cells scattered in the parenchyma.

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