Intracranial solitary fibrous tumor: Difficulties in differential diagnosis of tumors and tumor-like lesions in a patient with HIV-infection: case report and literature review

Based on current World Health Organization statistics, today there were an estimated 40 million people living with HIV. The specific epidemiological course of HIV infection is represented by a wide range of severe forms of diseases with a predominance of involvement of the central nervous system in the pathological process. Due to the variability of cerebral lesions, there are difficulties in identifying and diagnosing the pathological process, especially when it comes to a tumor process unrelated to HIV infection. A 40-year old man presented with left hemiparesis and headaches. He was diagnosed with human immunodeficiency virus (HIV) in 2020 and does not treat using antiretroviral (ARV) drugs. The CD4 + lymphocyte level was 180 cells/μl. The titers of antibodies to T.gondii were 1:400. Brain magnetic resonance imaging (MRI) revealed an intraaxial mass in the basal ganglia region on the right side, with ring-shaped contrast enhancement, restricted diffusion and extensive perifocal edema, small foci of hemorrhages and vascular shunts, and high perfusion levels. The patient underwent a stereotactic biopsy of the brain mass and postoperative pathological report confirmed the diagnosis of a primary neuroepithelial tumor: Glioblastoma, Not Otherwise Specified (NOS, WHO 2021). Correct and timely detection of the nature of brain lesion is necessary to select the correct treatment strategies and, as a result, reduce mortality. The use of multiparametric MRI protocol recommended to the differential diagnosis of brain lesions in patients with HIV infection.