title: Human African trypanosomiasis: diagnosis, relapse and survival after severe melarsoprol-induced encephalopathy.
abstract: We describe a case of human African trypanosomiasis with a number of unusual features. The clinical presentation was subacute, but the infection was shown to be due to Trypanosoma brucei rhodesiense. The infection relapsed twice following treatment and the patient developed a melarsoprol-associated encephalopathy. Magnetic resonance imaging (MRI) findings were suggestive of microhaemorrhages, well described in autopsy studies of encephalopathy but never before shown on MRI. The patient survived severe encephalopathy with a locked-in syndrome. Our decision to provide ongoing life support may be useful to physicians treating similar cases in a setting where intensive care facilities are available.
authors.affiliation: Hospital for Tropical Diseases, London, UK; University College Hospital, London, UK. annacheckley@yahoo.com
authors.forename: A M
authors.initials: AM
authors.lastname: Checkley
authors.forename: J
authors.initials: J
authors.lastname: Pepin
authors.forename: W C
authors.initials: WC
authors.lastname: Gibson
authors.forename: M N
authors.initials: MN
authors.lastname: Taylor
authors.forename: H R
authors.initials: HR
authors.lastname: Jäger
authors.forename: D C
authors.initials: DC
authors.lastname: Mabey
mesh_terms: D000328:Adult; D000818:Animals; D001927:Brain Diseases / Q000139:chemically induced* / Q000175:diagnosis; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008549:Melarsoprol / Q000009:adverse effects* / Q000627:therapeutic use; D016133:Polymerase Chain Reaction / Q000379:methods; D012008:Recurrence; D014344:Trypanocidal Agents / Q000009:adverse effects* / Q000627:therapeutic use; D016833:Trypanosoma brucei rhodesiense / Q000145:classification; D014353:Trypanosomiasis, African / Q000175:diagnosis* / Q000188:drug therapy / Q000401:mortality
chemical_list: D014344:Trypanocidal Agents; D008549:Melarsoprol