This week's artwork was donated by Lonny, a pediatric cancer patient who received treatment at The Children's Hospital of Philadelphia . These patients usually have evidence of far advanced AIDS, are severely debilitated, and present with focal neurologic symptoms such as seizures and paralysis. Computed tomographic scans show contrast-enhancing mass lesions that may not always be distinguished from other CNS diseases, such as toxoplasmosis, that occur in AIDS patients.
Lymphoma tends to present with large lesions, which are enhanced by gadolinium.
In cerebral toxoplasmosis, ring enhancement is very common, lesions tend to be smaller, and multiple lesions are seen. Antibodies against toxoplasmosis may also be very useful, since the vast majority of cerebral toxoplasmosis occur as a consequence of reactivity of a previous infection. Primary CNS lymphoma is often identified as a terminal manifestation of AIDS or on postmortem examination. Radiation therapy alone has usually been used in this group of patients. With doses in the 3500 to 4000 cGy range, median duration of survival has been only 72 to 119 days.