title: Toxoplasma gondii meningoencephalitis without cerebral MRI findings in a patient with ulcerative colitis under immunosuppressive treatment.
abstract: Toxoplasmosis is the most common opportunistic infection of the central nervous system in immunosupressed patients. It is usually presented as a space-occupying lesion detected by cerebral computerized tomography or magnetic resonance imaging. The diffuse form of the disease (diffuse toxoplasmic meningoencephalitis) lacks the characteristic cerebral radiologic findings rendering pre-mortem diagnosis much more difficult. Herein, we describe a case of toxoplasmic menincoencephalitis, without evidence of cerebral space-occupying lesions, in a patient with ulcerative colitis under combined therapy with systemic glucocorticoids and azathioprine. Diagnosis was based on microscopic examination of cerebrospinal fluid (CSF) for the parasite, whereas, RT-PCR for Toxoplasma gondii was negative. Taking into consideration the limitations of molecular methods, investigation of the etiology of meningeal involvement in patients under immunosuppressive therapy presenting positive serology of previous T. gondii infection, should include microscopic examination of CSF for parasite presence.
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, University General Hospital of Patras, 26504, Patras, Greece.
authors.forename: S F
authors.initials: SF
authors.lastname: Assimakopoulos
authors.affiliation: Department of Microbiology, University General Hospital of Patras, 26504, Patras, Greece.
authors.forename: V
authors.initials: V
authors.lastname: Stamouli
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, University General Hospital of Patras, 26504, Patras, Greece.
authors.forename: D
authors.initials: D
authors.lastname: Dimitropoulou
authors.affiliation: Department of Microbiology, University General Hospital of Patras, 26504, Patras, Greece.
authors.forename: A
authors.initials: A
authors.lastname: Spiliopoulou
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, University General Hospital of Patras, 26504, Patras, Greece.
authors.forename: G
authors.initials: G
authors.lastname: Panos
authors.affiliation: Department of Microbiology, University General Hospital of Patras, 26504, Patras, Greece.|Department of Microbiology, School of Medicine, University of Patras, 26504, Patras, Greece.
authors.forename: E D
authors.initials: ED
authors.lastname: Anastassiou
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, University General Hospital of Patras, 26504, Patras, Greece.
authors.forename: M
authors.initials: M
authors.lastname: Marangos
authors.affiliation: Department of Microbiology, University General Hospital of Patras, 26504, Patras, Greece. spiliopl@upatras.gr.|Department of Microbiology, School of Medicine, University of Patras, 26504, Patras, Greece. spiliopl@upatras.gr.
authors.forename: I
authors.initials: I
authors.lastname: Spiliopoulou
mesh_terms: D000328:Adult; D001379:Azathioprine / Q000009:adverse effects / Q000627:therapeutic use; D001921:Brain / Q000000981:diagnostic imaging / Q000473:pathology*; D002555:Cerebrospinal Fluid / Q000469:parasitology; D003093:Colitis, Ulcerative / Q000150:complications* / Q000188:drug therapy*; D005260:Female; D005938:Glucocorticoids / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects* / Q000627:therapeutic use*; D008279:Magnetic Resonance Imaging; D008853:Microscopy; D011859:Radiography; D014122:Toxoplasma / Q000302:isolation & purification*; D016781:Toxoplasmosis, Cerebral / Q000175:diagnosis* / Q000473:pathology
chemical_list: D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D001379:Azathioprine
keywords: CSF; Immunosuppression; Meningoencephalitis; Microscopy; Toxoplasma gondii; Ulcerative colitis