title: Recurrent seizures during acute acquired toxoplasmosis in an immunocompetent traveller returning from Africa.
abstract: BACKGROUND
  We report an unusual case of acute acquired toxoplasmosis (AAT) presenting as lymphadenopathy and recurrent seizures in an immunocompetent 15-year-old boy.
  
  
  METHODS
  The patient reported an 18-day vacation to Africa (Ethiopia), 39 days prior to the first seizure. Electroencephalogram (EEG) showed sporadic single-spike or sharp-wave paroxysms and the magnetic resonance imaging (RMI) of the brain was negative. The serology for T. gondii was compatible with an acute infection defined as positive for both toxoplasma-specific IgG and IgM and a low avidity (6 %), confirmed by a reference laboratory. The patient reported other two episodes of seizures, occurring 7 days apart. He was treated with pyrimethamine plus sulfadiazine and leucovorin for 4 weeks, with an improvement of lymphadenitis and normalization of EEG. After 5 months, new seizures were reported and a diagnosis of epilepsy was done. Toxoplasma polymerase chain reaction (PCR) of cerebrospinal fluid (CSF) and blood were negative. A treatment with valproic acid was started, obtaining control of the neurological disease.
  
  
  CONCLUSIONS
  Awareness of this neurologic manifestation by clinicians is required, also in immunocompetent patients. The relationship between toxoplasmosis and recurrent seizure needs to be investigated by new studies.
authors.affiliation: Centre for Tropical Diseases, Sacro Cuore Hospital, via Sempreboni 5, 37024, Negrar, Italy. anna.beltrame@sacrocuore.it.|Clinic of Infectious Diseases, Azienda Ospedaliero-Universitaria di Udine, Udine, Italy. anna.beltrame@sacrocuore.it.
authors.forename: Anna
authors.identifier: http://orcid.org/0000-0002-7499-5843
authors.initials: A
authors.lastname: Beltrame
authors.affiliation: Clinic of Infectious Diseases, Azienda Ospedaliero-Universitaria di Udine, Udine, Italy.
authors.forename: Sergio
authors.initials: S
authors.lastname: Venturini
authors.affiliation: Department of Paediatrics, Azienda Ospedaliero-Universitaria di Udine, Udine, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Crichiutti
authors.affiliation: Department of Internal Medicine and Therapeutics, Microbiology and Virology Department Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy.
authors.forename: Valeria
authors.initials: V
authors.lastname: Meroni
authors.affiliation: Centre for Tropical Diseases, Sacro Cuore Hospital, via Sempreboni 5, 37024, Negrar, Italy.
authors.forename: Dora
authors.initials: D
authors.lastname: Buonfrate
authors.affiliation: Clinic of Infectious Diseases, Azienda Ospedaliero-Universitaria di Udine, Udine, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Bassetti
mesh_terms: D000293:Adolescent; D000913:Antibodies, Protozoan / Q000097:blood; D000927:Anticonvulsants / Q000627:therapeutic use; D000981:Antiprotozoal Agents / Q000627:therapeutic use; D004827:Epilepsy / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D005002:Ethiopia; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D007075:Immunoglobulin M / Q000097:blood; D002955:Leucovorin / Q000627:therapeutic use; D008297:Male; D011739:Pyrimethamine / Q000627:therapeutic use; D012008:Recurrence; D012640:Seizures / Q000175:diagnosis* / Q000473:pathology; D013411:Sulfadiazine / Q000627:therapeutic use; D014122:Toxoplasma / Q000276:immunology; D014123:Toxoplasmosis / Q000150:complications* / Q000175:diagnosis* / Q000473:pathology; D014195:Travel; D016896:Treatment Outcome; D014635:Valproic Acid / Q000627:therapeutic use
chemical_list: D000913:Antibodies, Protozoan; D000927:Anticonvulsants; D000981:Antiprotozoal Agents; D007074:Immunoglobulin G; D007075:Immunoglobulin M; D013411:Sulfadiazine; D014635:Valproic Acid; D002955:Leucovorin; D011739:Pyrimethamine
keywords: Acute acquired toxoplasmosis; Immunocompetent; Seizure; Toxoplasma gondii; Travel