Diagnostic and Therapeutic Paradoxes in PCR-Positive, Histopathology-Negative CNS Aspergillosis in A Patient with HIV and Hodgkin Lymphoma.

Background: Invasive central nervous system (CNS) aspergillosis is rare among human immunodeficiency virus (HIV)-positive patients due to preserved neutrophil function, despite significant CD4+ T-cell depletion. Diagnosis typically requires histopathologic confirmation, but polymerase chain reaction (PCR) testing has introduced new challenges due to its high sensitivity but limited specificity. Case presentation: We describe a newly diagnosed 43-year-old HIV-positive male with concurrent Hodgkin lymphoma who presented with progressive neurological decline and a ring-enhancing brain lesion. While histopathological analysis of the brain biopsy demonstrated features of HIV-associated leukoencephalopathy, PCR testing paradoxically identified Discussion: This case underscores the diagnostic and therapeutic complexities of PCR-positive, histopathology-negative CNS aspergillosis in HIV. Overreliance on molecular results without confirmatory pathology may lead to unnecessary antifungal therapy and severe drug toxicity. Additionally, overlapping immunosuppressive conditions-such as HIV and lymphoma-complicate clinical interpretation and management. Conclusion: In HIV-positive patients with CNS lesions, PCR detection of LEARNING POINTS: Polymerase chain reaction positivity for