Cerebral Toxoplasmosis in a Previously Fit Individual – Pitfalls in Management – A Case Report.
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Abstract
Most people with toxoplasmosis infection are asymptomatic. Cerebral toxoplasmosis in HIV patient represents poor prognostic determinant, but treatable if early treatment is initiated. A case of delayed diagnosis of cerebraltoxoplasmosis is presented.A 27-year-old man presented with one-sided facial numbness and treated as Bell’s Palsy. Later he developed slurred speech. Contrast enhanced CT brain showed left frontal temporal hypodense lesion, leptomeningeal enhancement and perilesional oedema. Steroid was started. Four days later, he presented with decreased responsiveness. Retroviral was detected and diagnosis changed to opportunistic brain infection. He died after 3 days. Toxoplasmosis IgG antibodies turned out positive.In diagnosing cerebral toxoplasmosis, clinical presentation and examination are as important as laboratory testing and radiological imaging.
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8. Osborn AG, Salzman KL, Jhaveri MD, Barkovich AJ. Diagnostic imaging: brain. Elsevier Health Sciences; 2015 Dec 24.
9. Azovtseva OV, Viktorova EA, Bakulina EG, Shelomov AS, Trofimova TN. Cerebral toxoplasmosis in HIV-infected patients over 2015-2018 (a case study of Russia). Epidemiology and Infection. 2020 May 4; 148: e142. PMID: 32364106; PMCID: PMC7374806. https://doi.org/10.1017/S0950268820000928
10. Bhagavati S, Choi J. Frequent hemorrhagic lesions in cerebral toxoplasmosis in AIDS patients. Journal of Neuroimaging. 2009 Apr; 19(2): 169-73. PMID: 19705517. https://doi.org/10.1111/ j.1552-6569.2008.00274.x
11. Vidal JE. HIV-Related Cerebral Toxoplasmosis Revisited: Current Concepts and Controversies of an Old Disease. Journal of the International Association Providers of AIDS Care. 2019 Jan-Dec; 18: 2325958219867315. PMID: 31429353; PMCID: PMC6900575. https://doi.org/10.1177/2325958219867315
12. Levy RM, Mills CM, Posin JP, Moore SG, Rosenblum ML, Bredesen DE. The efficacy and clinical impact of brain imaging in neurologically symptomatic AIDS patients: a prospective CT/MRI study. Journal of the Acquired Immune Deficiency Syndromes (1988). 1990; 3(5): 461-71. PMID: 2324943. https:// doi.org/10.1097/00126334-199005000-00001
2. Luft BJ, Conley F, Remington JS, Laverdiere M, Wagner KF, Levine JF, et al. Outbreak of central-nervous-system toxoplasmosis in western Europe and North America. Lancet. 1983 Apr 9; 1(8328): 781-4. PMID: 6132129. https://doi.org/10.1016/ S0140-6736(83)91847-0
3. Porter SB, Sande MA. Toxoplasmosis of the central nervous system in the acquired immunodeficiency syndrome. New England Journal of Medicine. 1992; 327: 1643-1648. https:// doi.org/10.1056/NEJM199212033272306
4. Kaplan JE, Benson C, Holmes KK, Brooks JT, Pau A, Masur H; Centers for Disease Control and Prevention (CDC); National Institutes of Health; HIV Medicine Association of the Infectious Diseases Society of America. Guidelines for prevention and treatment of opportunistic infections in HIV-infected adults and adolescents: recommendations from CDC, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America. MMWR Recomm Rep. 2009 Apr 10; 58(RR-4): 1-207 https://doi.org/10.1037/ e537722009-001
5. Sonneville R, Schmidt M, Messika J, Ait Hssain A, da Silva D, Klein IF, et al. Neurologic outcomes and adjunctive steroids in HIV patients with severe cerebral toxoplasmosis. Neurology. 2012 Oct 23. 79(17): 1762-6. Epub 2012 Oct 10. PMID: 23054235. https://doi.org/10.1212/WNL.0b013e3182704040
6. Luft BJ, Hafner R, Korzun AH, Leport C, Antoniskis D, Bosler EM, et al. Toxoplasmic encephalitis in patients with the acquired immunodeficiency syndrome. Members of the ACTG 077p/ ANRS 009 Study Team. New England Journal of Medicine. 1993 Sep 30; 329(14): 995-1000. PMID: 8366923. https://doi. org/10.1056/NEJM199309303291403
7. Arens J, Barnes K, Crowley N, Maartens G. Treating AIDS- associated cerebral toxoplasmosis - pyrimethamine plus sulfadiazine compared with cotrimoxazole, and outcome with adjunctive glucocorticoids. South African Medical Journal. 2007 Oct; 97(10): 956-8. PMID: 18000578.
8. Osborn AG, Salzman KL, Jhaveri MD, Barkovich AJ. Diagnostic imaging: brain. Elsevier Health Sciences; 2015 Dec 24.
9. Azovtseva OV, Viktorova EA, Bakulina EG, Shelomov AS, Trofimova TN. Cerebral toxoplasmosis in HIV-infected patients over 2015-2018 (a case study of Russia). Epidemiology and Infection. 2020 May 4; 148: e142. PMID: 32364106; PMCID: PMC7374806. https://doi.org/10.1017/S0950268820000928
10. Bhagavati S, Choi J. Frequent hemorrhagic lesions in cerebral toxoplasmosis in AIDS patients. Journal of Neuroimaging. 2009 Apr; 19(2): 169-73. PMID: 19705517. https://doi.org/10.1111/ j.1552-6569.2008.00274.x
11. Vidal JE. HIV-Related Cerebral Toxoplasmosis Revisited: Current Concepts and Controversies of an Old Disease. Journal of the International Association Providers of AIDS Care. 2019 Jan-Dec; 18: 2325958219867315. PMID: 31429353; PMCID: PMC6900575. https://doi.org/10.1177/2325958219867315
12. Levy RM, Mills CM, Posin JP, Moore SG, Rosenblum ML, Bredesen DE. The efficacy and clinical impact of brain imaging in neurologically symptomatic AIDS patients: a prospective CT/MRI study. Journal of the Acquired Immune Deficiency Syndromes (1988). 1990; 3(5): 461-71. PMID: 2324943. https:// doi.org/10.1097/00126334-199005000-00001
| Files | ||
| Issue | Vol 7 No 6 (2022): November-December | |
| Section | Case Report(s) | |
| DOI | https://doi.org/10.18502/crcp.v7i6.12273 | |
| Keywords | ||
| Cerebral toxoplasmosis Toxoplasmosis; Patient Immunocompromised Case report | ||
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How to Cite
1.
Salleh N, Zaim R, Udin S. Cerebral Toxoplasmosis in a Previously Fit Individual – Pitfalls in Management – A Case Report. CRCP. 2023;7(6):284-289.
