Gastric Toxoplasmosis as the Presentation of Acquired Immunodeficiency Syndrome

Abstract

We report a case of a 39-year-old West African man with unknown human immunodeficiency virus status diagnosed with gastric toxoplasmosis as the presenting manifestation of acquired immunodeficiency syndrome. Toxoplasma gondii is common in severely immunosuppressed patients and most frequently involves the central nervous system, followed by the eye, myocardium and skeletal muscle, lungs, bone marrow, and peripheral blood. For unclear reasons, gastrointestinal involvement is exceedingly rare and occurs in the context of severe immunosuppression and disseminated disease. To our knowledge, this is the first report in the English literature of a patient with isolated, manifest gastric toxoplasmosis without evidence of concomitant cerebral or extracerebral involvement. It is important for both the clinician and the pathologist to maintain a high index of suspicion for toxoplasmosis in immunosuppressed patients presenting with nonspecific symptoms of gastritis and radiologic and endoscopic presence of thickened gastric folds with or without ulceration.

Microbes, Viruses and Parasites in AIDS Process

“…Therefore, disseminated toxoplasmosis should be considered in the differential diagnosis of AIDS patients with culture-negative cystitis (Welker et al, 1994). For unclear reasons, gastrointestinal involvement is exceedingly rare and occurs only in the context of severe immunosuppression and disseminated disease (Merzianu et al, 2005). Gastric toxoplasmosis has been reported in AIDS patients.…”

“…Biopsy shows the presence of Toxoplasma trophozoites in the forms of tachyzoites, bradyzoites, and pseudocysts which are mandatory for definite diagnosis. It responds well to anti-Toxoplasma therapy (Alpert et al, 1996;Merzianu et al, 2005). It is of interest, that disseminated toxoplasmosis with sepsis has also been found in AIDS patients and should be considered in patients with sepsis of unknown origin (Artigas et al, 1994).…”