Meningoencephalitis and new onset of seizures in a patient with normal brain CT and multiple lesions on MRI.
Toxoplasmic encephalitis is the most common cerebral mass lesion in patients with AIDS. The definitive diagnosis requires direct demonstration of the tachyzoite form of Toxoplasma gondii in cerebral tissue. The presumptive diagnosis is based on serology, clinical and radiological features, and on response to anti-Toxoplasma therapy. Typically, patients have a subacute presentation of focal neurological signs, with multiple lesions in computed tomography (CT) or magnetic resonance imaging (MRI). However, the neurological and CT scan spectrum is broad. We report a case of toxoplasmic encephalitis in a heterosexual man without prior history of HIV infection. He was admitted with four days of headache, confusion, and new onset of seizures. His brain CT disclosed no alterations and MRI revealed multiple lesions. Empirical specific anti-Toxoplasma therapy was initiated and the patient experienced excellent clinical and radiological improvement. His HIV tests were positive and the CD4+ cell count was 74 cells/ml (8.5 %). On follow up, three months later, the general state of the patient was good, without neurological sequelae and with a normal MRI. We concluded that toxoplasmic encephalitis should be considered in the differential diagnosis of meningoencephalitis in sexually active individuals, including cases without prior history or suspicion of HIV infection, and no abnormalities on CT scan.
Institute of Infectious Diseases Emílio Ribas, São Paulo, SP, Brazil. jbermudez@emilioribas.sp.gov.br
José E
JE
Vidal
Anne
A
Spichler
Augusto C P de
AC
Oliveira
André Villela
AV
Lomar
D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000469:parasitology; D019380:Anti-HIV Agents / Q000627:therapeutic use; D000981:Antiprotozoal Agents / Q000627:therapeutic use; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008590:Meningoencephalitis / Q000175:diagnosis* / Q000188:drug therapy / Q000469:parasitology; D008875:Middle Aged; D012640:Seizures / Q000175:diagnosis / Q000209:etiology; D014057:Tomography, X-Ray Computed; D016781:Toxoplasmosis, Cerebral / Q000175:diagnosis* / Q000188:drug therapy
D019380:Anti-HIV Agents; D000981:Antiprotozoal Agents