title: Intracranial toxoplasmosis presenting as panhypopituitarism in an immunocompromised patient.
abstract: A 37-year-old man presented with worsening headache, vomiting, and right-sided weakness over the last few weeks. A head computed tomography showed a left hemispheric posterior medial parietal lobe lesion with surrounding edema. Further imaging with magnetic resonance imaging showed multiple enhancing mass lesions. The largest lesion measured 2.4 cm within the left occipital parietal region (Figure A and B). Laboratory data showed reactive HIV antibodies, confirmed by Western blot. An absolute CD4 count was 22 cells/μL. Other laboratory test results showed low sodium, thyrotropin, FT4, FT3, cortisol levels, corticotropin, luteinizing hormone, and testosterone. Based on these findings, the brain lesions were believed to be causing his panhypopituitarism. A brain biopsy confirmed the presence of Toxoplasma gondii by polymerase chain reaction. The patient was started on pyrimethamine and clindamycin for toxoplasmosis treatment, and azithromycin and sulfamethoxazole/trimethoprime for appropriate prophylaxis. He was also started on hormone supplementation. His symptoms were completely resolved at the time of discharge.
authors.affiliation: Creighton University School of Medicine, Department of Internal Medicine, Omaha, NE, USA. Electronic address: shadihamdeh@creighton.edu.
authors.forename: Shadi
authors.initials: S
authors.lastname: Hamdeh
authors.affiliation: Creighton University School of Medicine, Department of Internal Medicine, Omaha, NE, USA.
authors.forename: Anum
authors.initials: A
authors.lastname: Abbas
authors.affiliation: Creighton University School of Medicine, Department of Internal Medicine, Omaha, NE, USA.
authors.forename: Jessica
authors.initials: J
authors.lastname: Fraker
authors.affiliation: Creighton University School of Medicine, Department of Internal Medicine, Omaha, NE, USA.
authors.forename: J E
authors.initials: JE
authors.lastname: Lambrecht
mesh_terms: D000328:Adult; D001706:Biopsy; D003937:Diagnosis, Differential; D006801:Humans; D007018:Hypopituitarism / Q000175:diagnosis; D016867:Immunocompromised Host; D008297:Male; D016133:Polymerase Chain Reaction; D014057:Tomography, X-Ray Computed; D016781:Toxoplasmosis, Cerebral / Q000175:diagnosis* / Q000188:drug therapy