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Cerebellar toxoplasmosis in HIV/AIDS: a case report.

Abstract

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.

CONCLUSION

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.

Authors+Show Affiliations

,

Dermatology Unit, Department of Medicine, University of Benin Teaching Hospital, Benin City, Nigeria.

,

Source

MeSH

AIDS-Related Opportunistic Infections
Adult
Anti-Bacterial Agents
Central Nervous System Diseases
HIV Infections
HIV-1
Humans
Male
Nigeria
Pyridoxine
Recurrence
Tomography, X-Ray Computed
Toxoplasmosis, Cerebral
Treatment Outcome
Vitamin B Complex

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

20544640

Citation

Emeka, E U., et al. "Cerebellar Toxoplasmosis in HIV/AIDS: a Case Report." West African Journal of Medicine, vol. 29, no. 2, 2010, pp. 123-6.
Emeka EU, Ogunrin AO, Olubunmi A. Cerebellar toxoplasmosis in HIV/AIDS: a case report. West Afr J Med. 2010;29(2):123-6.
Emeka, E. U., Ogunrin, A. O., & Olubunmi, A. (2010). Cerebellar toxoplasmosis in HIV/AIDS: a case report. West African Journal of Medicine, 29(2), pp. 123-6.
Emeka EU, Ogunrin AO, Olubunmi A. Cerebellar Toxoplasmosis in HIV/AIDS: a Case Report. West Afr J Med. 2010;29(2):123-6. PubMed PMID: 20544640.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cerebellar toxoplasmosis in HIV/AIDS: a case report. AU - Emeka,E U, AU - Ogunrin,A O, AU - Olubunmi,A, PY - 2010/6/15/entrez PY - 2010/6/15/pubmed PY - 2010/10/27/medline SP - 123 EP - 6 JF - West African journal of medicine JO - West Afr J Med VL - 29 IS - 2 N2 - 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. CONCLUSION: 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. SN - 0189-160X UR - https://www.unboundmedicine.com/medline/citation/20544640/Cerebellar_toxoplasmosis_in_HIV/AIDS:_a_case_report_ L2 - http://www.diseaseinfosearch.org/result/279 DB - PRIME DP - Unbound Medicine ER -