Mesencephalic tuberculous abcess in a patient with AIDS

Araújo-Filho, Stélio da Conceição; Maia, Laerte; Silva, Harley Brito da; Almeida, João Paulo; Albuquerque, Lucas Alverne Freitas de

doi:10.1590/s0004-282x2008000200026

Cited by 2 publications

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“…Therefore, the presence of an intracranial mass in a patient with AIDS allows empiric treatment for cerebral toxoplasmosis, and failure to respond to therapy within the first 2 weeks dictates the need for a stereotactic biopsy. 6,7 Although a definitive diagnosis of CNS toxoplasmosis relies on the identification of parasites by histopathology, the clinical and radiologic data can be complemented by a less invasive approach that confirms the presence of parasites in the CSF. In a recent study, a positive PCR as in our case has been found to have high sensitivity and specificity (83.3% and 97.5%, respectively).…”

Section: Discussionmentioning

confidence: 99%

Solitary Hypothalamopituitary Toxoplasmosis Abscess in a Patient with AIDS

Legrand

Catherine²,

Brivet³

et al. 2010

AJNR Am J Neuroradiol

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SUMMARY:Toxoplasmosis is a disease caused by an obligate intracellular protozoal parasite, Toxoplasma gondii. It is the most common cause of focal brain lesions in patients with AIDS. The imaging features and endocrine disorders of CNS toxoplasmosis in patients with AIDS are reviewed.ABBREVIATIONS: CNS ϭ central nervous system; FLAIR ϭ fluid-attenuated inversion recovery; HIV ϭ human immunodeficiency virus; PCR ϭ polymerase chain reaction T oxoplasmosis is the most common cause of focal brain lesions in patients with AIDS, 1 even if the number of cases has declined with the introduction of highly active antiretroviral therapy. Neuroimaging usually reveals multiple nodular or ring-enhancing lesions with edema and mass effect.2 The clinical manifestations are nonspecific and depend on the location of the lesions. Focal neurologic symptoms are often superimposed on global encephalopathy. Infections of endocrine organs result in endocrine disorders. We present a unique case of solitary hypothalamopituitary toxoplasmosis abscess causing central diabetes insipidus and corticotropic insufficiency and revealing AIDS. Case ReportA 36-year-old woman consulted us for fever and pain in the maxillary area. She was treated with amoxicillin, clavulanate potassium, and corticotherapy for 8 days for suspicion of sinusitis. Persistence of fever led to another antibiotic treatment (levofloxacin) for 9 days. Seven days later, she was admitted to the emergency department for confusion, hypothermia, and hypotension.Unenhanced CT revealed a 15-mm area of abnormal low attenuation centered on the optic chiasm and hypothalamic region. This area demonstrated ring enhancement on postcontrast CT images. MR imaging confirmed the single character of the lesion, which was hyperintense on T2-weighted sequences and surrounded by high-signal-intensity vasogenic edema involving the optic tract, cerebral peduncles, anterior commissure, internal parts of the temporal lobes, and posterior arms of the internal capsules. The lesion was isointense on T1-weighted sequences, with an asymmetric target sign (a small eccentric nodule along the wall of the enhancing ring) on postcontrast sequences.3 The pituitary stalk was thickened (Fig 1). A rapid screening test was positive for HIV. Examination of blood revealed lymphopenia and 8 CD4 cells/mm 3 . Serum toxoplasma immunoglobulin G was positive. Testing of CSF revealed no pleocytosis but elevated levels of protein, hypoglycorrhachia, and a PCR positive for Toxoplasma gondii. Treatment was started, including pyrimethamine, sulfadiazine, and folinic acid. In addition, the patient received antibiotics for 3 days on the basis of the hypothesis of pyogenic abscess. At day 3, the patient developed polyuria and polydipsia. Natremia and plasma osmolality were high whereas urine osmolality was low. Response to vasopressin led to the diagnosis of diabetes insipidus. Endocrine testing was performed, revealing a corticotropic insufficiency, which was treated with hydrocortisone. The hypothalamothyroid axis was not distu...

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Section: Discussionmentioning

confidence: 99%