Congenital toxoplasmosis presenting as central diabetes insipidus in an infant: a case report

Abstract

BackgroundCongenital toxoplasmosis has a wide range of presentation at birth varying from severe neurological features such as hydrocephalus and chorioretinitis to a well appearing baby, who may develop complications late in infancy. While neuroendocrine abnormalities associated with congenital toxoplasmosis are uncommon, isolated central diabetes insipidus is extremely rare.Case presentationHere, we report on a female infant who presented with fever, convulsions, and polyuria. Examination revealed weight and length below the 3rd centile along with signs of severe dehydration. Fundal examination showed bilateral chorioretinitis. This infant developed hypernatremia together with increased serum osmolality and decreased both urine osmolality and specific gravity consistent with central diabetes insipidus. Serology for toxoplasma specific immunoglobulin M was high for both the mother and the baby and polymerase chain reaction for toxoplasma deoxyribonucleic acid was positive in the infant confirming congenital toxoplasmosis. Brain computerized tomography scans demonstrated ventriculomegaly associated with cerebral and cortical calcifications. Fluid and electrolyte abnormalities responded to nasal vasopressin therapy.ConclusionThis report highlights central diabetes inspidus as a rare presentation of congenital toxoplasmosis.

Recurrent Fever in Children

“…In one case, recurrent episodes of fever occurring at 1-, 3- and 6-weeks of age associated with neurological and ocular abnormalities were attributed to dysfunction of the hypothalamic thermoregulatory center, secondary to congenital toxoplasma infection [ 79 ].…”

Late diagnosis of isolated central diabetes insipidus secondary to congenital toxoplasmosis—case report

“…The risk of congenital transmission depends on the timing of the maternal infection. It is <2% in the first trimester to >80% in the third trimester [ 2 ]. Congenital toxoplasmosis has a prevalence of 1–10 per 10 000 live births [ 3 ] and is typically subclinical.…”

Ventriculitis and hydrocephalus with hypoglycorrhachia in congenital toxoplasma infection

“…[ 1 3 ] Postcontrast periventricular enhancement on MR imaging is consistent with ventriculitis. [ 2 4 ] Though antitoxoplasma therapy alone may suffice and spontaneous resolution of hydrocephalus may be seen, the enlarging head circumference in our patient made CSF diversion compulsory. [ 4 ] We emphasize on early suspicion of toxoplasmosis in newborns with hydrocephalus and to proceed with CSF diversion for hydrocephalus despite persistent hypoglycorrhachia.…”

“…Radiology shows ring enhancing lesions at corticomedullary junction, white matter of basal ganglia (75–88%), thalamus or as diffuse cerebritis. [ 1 2 ] Ventriculitis and consecutive obstructive hydrocephalus may occur due to compression of CSF outflow pathway by ring enhancing lesions or ventriculitis. [ 1 3 ] Postcontrast periventricular enhancement on MR imaging is consistent with ventriculitis.…”