Cerebral toxoplasmosis and cryptococcal meningitis are severe opportunistic infections of the central nervous system (CNS) in HIV patients, particularly those with CD4 counts <200 cells/µL. Toxoplasmosis, caused by Toxoplasma gondii, is the most common CNS opportunistic infection, presenting with brain abscesses, headache, fever, and focal neurological deficits. Cryptococcal meningitis, caused by Cryptococcus neoformans, affects 5-10% of these patients, with symptoms including headache, fever, and mental status changes. Co-infection is rare and carries high mortality (up to 80%). We report the case of a 26-year-old man with newly diagnosed HIV who presented with bilateral paresis, visual impairment, bradyphasia, bradypsychia, and disorientation. Magnetic resonance imaging (MRI) revealed infiltrative lesions in the corpus callosum, hypothalamic region, and spinal cord, suggestive of toxoplasmosis or lymphoma. Lumbar puncture showed elevated opening pressure, leukocytes (111/mm³), low glucose (32 mg/dL), high protein (1842.8 mg/dL), and Cryptococcus neoformans on India ink staining. Cerebrospinal fluid PCR confirmed Toxoplasma gondii, establishing a dual infection. MR spectroscopy indicated neuronal loss (decreased N-acetylaspartate), inflammation (elevated choline), and anaerobic metabolism (lactate peak), consistent with both infections. Due to the unavailability of liposomal amphotericin B and flucytosine, treatment involved amphotericin B deoxycholate (0.8 mg/kg/day), fluconazole (1200 mg/day), and trimethoprim/sulfamethoxazole (640/3200 mg/day) for 2 weeks, followed by fluconazole consolidation (800 mg/day) and trimethoprim/sulfamethoxazole prophylaxis. The patient showed improvement in muscle strength, visual acuity, and alertness. Antiretroviral therapy (DGT/3TC/TDF) was initiated 6 weeks later. This case underscores the importance of comprehensive diagnostics and the efficacy of alternative treatment regimens in resource-limited settings, despite the rarity and severity of this co-infection.

Erick Jaasiel Ziga López is currently in his final year of Internal Medicine residency at Hospital General de Pachuca, Mexico. At the age of 29, he has been accepted into the prestigious Infectious Diseases subspecialty program at Hospital 20 de Noviembre, ISSSTE, Mexico City, starting in 2026, reflecting his commitment to advancing clinical expertise in infectology. Erick has demonstrated a strong dedication to medical education and research, particularly in the field of opportunistic infections in immunocompromised patients. He has authored one indexed publication in a peer-reviewed journal, focusing on central nervous system infections in HIV patients, which has contributed to the scientific community’s understanding of rare co-infections. Additionally, he has been actively involved in teaching pregraduate medical interns, preparing them for the ENARM exam through clinical case discussions and evidence-based practice. His academic interests include tuberculosis, HIV-related infections, and antimicrobial resistance, with a focus on improving public health outcomes in Mexico. Erick aims to integrate ethical clinical practice with scientific research, aspiring to contribute to Mexico’s public health system through innovative approaches to infectious disease management.