Cerebellar toxoplasmosis in HIV/AIDS: a case report.
BACKGROUND
Toxoplasma encephalitis is a common presentation of Toxoplasma gondii infection of the central nervous system in the late stage of human immunodeficiency viral (HIV) infection. The definitive diagnosis requires demonstration of toxoplasma in brain tissue. However, neuroradiologic demonstration (using Computed Tomography or Magnetic Resonance Imaging) of ring-enhanced multiple or single focal intracranial lesions in the presence of immunosuppression and prompt response to presumptive therapy are diagnostic in the absence of histological facilities. The rarity of toxoplasma lesions in the cerebellum prompts a high index of clinical suspicion and early institution of presumptive therapy in poor resource sub-Saharan countries like Nigeria.


OBJECTIVE
To illustrate the presentation of recurrent cerebellar toxoplasmosis in a patient with HIV/AIDS.


METHODS
A 34-year-old previously diagnosed HIV/AIDS male patient with right-sided cerebellar signs on neurological evaluation and a ring-enhancing lesion in the right cerebellar hemisphere on CT brain scan. An initial response to antitoxoplasmic drugs was short-lived due to poor compliance resulting in recurrence of lesion.


RESULTS
On initial evaluation a diagnosis of cerebellar space occupying lesion in a patient with HIV/AIDS was made. He responded to treatment with clindamycin, pyremethamine and pyridoxine. Following default in treatment for three months he represented with florid cerebellar features, but again responded rapidly to treatment.


CONCLUSIONS
Cerebellar toxoplasmosis is an infrequent complication of HIV/AIDS. Early diagnosis with neuro-imaging techniques and prompt institution of appropriate therapy results in remarkable improvement.
Emeka
E U
EU
Dermatology Unit, Department of Medicine, University of Benin Teaching Hospital, Benin City, Nigeria.
Ogunrin
A O
AO
Olubunmi
A
A
D017088:AIDS-Related Opportunistic Infections / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002493:Central Nervous System Diseases / Q000150:complications / Q000188:drug therapy; D015658:HIV Infections / Q000150:complications*; D015497:HIV-1; D006801:Humans; D008297:Male; D009549:Nigeria; D011736:Pyridoxine / Q000627:therapeutic use; D012008:Recurrence; D014057:Tomography, X-Ray Computed; D016781:Toxoplasmosis, Cerebral / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D016896:Treatment Outcome; D014803:Vitamin B Complex / Q000627:therapeutic use
D000900:Anti-Bacterial Agents; D014803:Vitamin B Complex; D011736:Pyridoxine