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Meningoencephalitis and new onset of seizures in a patient with normal brain CT and multiple lesions on MRI.
Braz J Infect Dis 2004; 8(1):115-7BJ

Abstract

Toxoplasmic encephalitis is the most common cerebral mass lesion in patients with AIDS. The definitive diagnosis requires direct demonstration of the tachyzoite form of Toxoplasma gondii in cerebral tissue. The presumptive diagnosis is based on serology, clinical and radiological features, and on response to anti-Toxoplasma therapy. Typically, patients have a subacute presentation of focal neurological signs, with multiple lesions in computed tomography (CT) or magnetic resonance imaging (MRI). However, the neurological and CT scan spectrum is broad. We report a case of toxoplasmic encephalitis in a heterosexual man without prior history of HIV infection. He was admitted with four days of headache, confusion, and new onset of seizures. His brain CT disclosed no alterations and MRI revealed multiple lesions. Empirical specific anti-Toxoplasma therapy was initiated and the patient experienced excellent clinical and radiological improvement. His HIV tests were positive and the CD4+ cell count was 74 cells/ml (8.5 %). On follow up, three months later, the general state of the patient was good, without neurological sequelae and with a normal MRI. We concluded that toxoplasmic encephalitis should be considered in the differential diagnosis of meningoencephalitis in sexually active individuals, including cases without prior history or suspicion of HIV infection, and no abnormalities on CT scan.

Authors+Show Affiliations

Institute of Infectious Diseases Emílio Ribas, São Paulo, SP, Brazil. jbermudez@emilioribas.sp.gov.br

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

15286884

Citation

Vidal, José E., et al. "Meningoencephalitis and New Onset of Seizures in a Patient With Normal Brain CT and Multiple Lesions On MRI." The Brazilian Journal of Infectious Diseases : an Official Publication of the Brazilian Society of Infectious Diseases, vol. 8, no. 1, 2004, pp. 115-7.
Vidal JE, Spichler A, Oliveira AC, et al. Meningoencephalitis and new onset of seizures in a patient with normal brain CT and multiple lesions on MRI. Braz J Infect Dis. 2004;8(1):115-7.
Vidal, J. E., Spichler, A., Oliveira, A. C., & Lomar, A. V. (2004). Meningoencephalitis and new onset of seizures in a patient with normal brain CT and multiple lesions on MRI. The Brazilian Journal of Infectious Diseases : an Official Publication of the Brazilian Society of Infectious Diseases, 8(1), pp. 115-7.
Vidal JE, et al. Meningoencephalitis and New Onset of Seizures in a Patient With Normal Brain CT and Multiple Lesions On MRI. Braz J Infect Dis. 2004;8(1):115-7. PubMed PMID: 15286884.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Meningoencephalitis and new onset of seizures in a patient with normal brain CT and multiple lesions on MRI. AU - Vidal,José E, AU - Spichler,Anne, AU - Oliveira,Augusto C P de, AU - Lomar,André Villela, Y1 - 2004/07/20/ PY - 2004/8/3/pubmed PY - 2004/9/28/medline PY - 2004/8/3/entrez SP - 115 EP - 7 JF - The Brazilian journal of infectious diseases : an official publication of the Brazilian Society of Infectious Diseases JO - Braz J Infect Dis VL - 8 IS - 1 N2 - Toxoplasmic encephalitis is the most common cerebral mass lesion in patients with AIDS. The definitive diagnosis requires direct demonstration of the tachyzoite form of Toxoplasma gondii in cerebral tissue. The presumptive diagnosis is based on serology, clinical and radiological features, and on response to anti-Toxoplasma therapy. Typically, patients have a subacute presentation of focal neurological signs, with multiple lesions in computed tomography (CT) or magnetic resonance imaging (MRI). However, the neurological and CT scan spectrum is broad. We report a case of toxoplasmic encephalitis in a heterosexual man without prior history of HIV infection. He was admitted with four days of headache, confusion, and new onset of seizures. His brain CT disclosed no alterations and MRI revealed multiple lesions. Empirical specific anti-Toxoplasma therapy was initiated and the patient experienced excellent clinical and radiological improvement. His HIV tests were positive and the CD4+ cell count was 74 cells/ml (8.5 %). On follow up, three months later, the general state of the patient was good, without neurological sequelae and with a normal MRI. We concluded that toxoplasmic encephalitis should be considered in the differential diagnosis of meningoencephalitis in sexually active individuals, including cases without prior history or suspicion of HIV infection, and no abnormalities on CT scan. SN - 1413-8670 UR - https://www.unboundmedicine.com/medline/citation/15286884/Meningoencephalitis_and_new_onset_of_seizures_in_a_patient_with_normal_brain_CT_and_multiple_lesions_on_MRI_ L2 - http://www.diseaseinfosearch.org/result/6489 DB - PRIME DP - Unbound Medicine ER -