Congenital Toxoplasmosis With Atypical Neuroimaging: Hydrocephalus and Bilateral Chorioretinitis Without Intracranial Calcifications.

We report a rare case of congenital toxoplasmosis in a 2-month-old female infant from rural Nepal, born to a primigravida mother without prenatal care. The infant presented with progressive lethargy, feeding difficulties, intermittent fever, and progressive macrocephaly. Neuroimaging revealed obstructive hydrocephalus and multiple cerebral ring-enhancing lesions without intracranial calcifications. Ophthalmologic examination demonstrated bilateral chorioretinitis. Serologic testing confirmed congenital toxoplasmosis. Despite initiation of standard therapy with pyrimethamine, sulfadiazine, and folinic acid, the infant experienced clinical deterioration prior to planned neurosurgical intervention. This case highlights the clinical and radiologic variability of congenital toxoplasmosis, the diagnostic challenges in resource-limited settings, and the importance of recognizing atypical imaging patterns to guide timely management.