[Diabetes insipidus as a manifestation of cerebral toxoplasmosis in an AIDS patient].
BACKGROUND
In AIDS patients the endocrine system is often affected. Diabetes insipidus (DI) is uncommon and has been related to drugs and infections of the central nervous system (toxoplasmosis, cryptococcic meningitis, cytomegalovirus encephalitis). In these patients at the time of diagnosis, imaging investigations are often normal.


METHODS
We report the case of a 40 year old man with infection category HIV C3 (CD4 < 50 mm3 and viral load 301,258 copies/ml), not on antiretroviral treatment at the time of hospital admission. He had polyuria (8-10 litres/day) and polydipsia for the previous 15 days, with no other symptoms. The dehydration test showed central DI (raised osmolarity following subcutaneous desmopresin). On MNR there were bilateral periventricular nodular images, also present in both caudate nuclei, with ring increased uptake following administration of paramagnetic contrast. On the clinical suspicion of cerebral toxoplasmosis empirical treatment was started with sulphadiazine and pyrimethamine together with nasal DDAVP, obtaining a good clinical response.


CONCLUSIONS
In patients with HIV infection, DI, although uncommon, may be the first sign of cerebral toxoplasmosis. Imaging studies may be pathological and assist diagnosis.
Servicio de Medicina Interna, Complejo Hospitalario de Cáceres, España.
J F
JF
Sánchez
M C
MC
Olmedo
F J
FJ
Pascua
I
I
Casado
D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis* / Q000188:drug therapy; D000163:Acquired Immunodeficiency Syndrome / Q000150:complications*; D000328:Adult; D000981:Antiprotozoal Agents / Q000627:therapeutic use; D001921:Brain / Q000000981:diagnostic imaging / Q000473:pathology; D003894:Deamino Arginine Vasopressin; D003919:Diabetes Insipidus / Q000209:etiology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D011739:Pyrimethamine / Q000627:therapeutic use; D011859:Radiography; D012076:Renal Agents; D013411:Sulfadiazine / Q000627:therapeutic use; D016781:Toxoplasmosis, Cerebral / Q000150:complications* / Q000175:diagnosis* / Q000188:drug therapy
D000981:Antiprotozoal Agents; D012076:Renal Agents; D013411:Sulfadiazine; D003894:Deamino Arginine Vasopressin; D011739:Pyrimethamine