Toxoplasmosis with early intracerebral hemorrhage in a patient with the acquired immunodeficiency syndrome

Abstract

Cerebral hemorrhage is a rare complication of the acquired immunodeficiency syndrome. We report a case of multifocal hemorrhage in a 37-year-old homosexual man with cerebral toxoplasmosis. Histopathologic examination, performed at cerebral autopsy, confirmed the findings on CT and MRI.

Intracerebral Haemorrhage in AIDS

“…Since there are few clinical reports of this complication [9, 10, 11, 12], it was also suggested that further studies are needed to define more precisely the relationship between both conditions [1]. In addition, only isolated case reports of ICH in AIDS patients have been published [13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24]. …”

“…Pinto [1] found that reported brain haemorrhages were usually due to thrombocytopenia, primary lymphoma of the CNS and metastasic Kaposi’s sarcoma. Other causes included circulating antibodies, antiphospholipid antibodies, disseminated intravascular coagulation, vascular malformations, mycotic aneurysm, cytomegalovirus infection, Aspergillus infection and, in particular, cerebral toxoplasmosis [14, 16, 20, 23, 24]. Toxoplasmosis induces a necrotizing encephalomyelitis and blood vessels may show fibrinoid necrosis with perivascular inflammatory response [4].…”

“…In our series we found (table 1) that lobar haemorrhages were related to systemic factors such as thrombocytopenia (cases 1 and 3) or hypertensive crisis (case 4), while in deep cerebral haemorrhages (cases 6–8) all patients had well-documented history of previous CNS infections, such as toxoplasmosis (cases 6 and 8) or tuberculosis (case 7) at the site where the haemorrhage later occurred. The relationship between CNS infections and brain haemorrhage has been documented, especially in patients with cerebral toxoplasmosis [12, 14, 16, 20, 23, 24] and may be explained by the possibility that these lesions (toxoplasmosis, Candida albicans, Aspergillus fumigatus , Cryptococcus, cytomegalovirus, syphilis, herpes zoster, tuberculosis or lymphomas) are associated with inflammatory changes in cerebral vessels [13, 22, 24]. A direct effect of HIV virus on cerebral vessels, suggested by other studies [3, 29], is also possible.…”

Unusual presentation of cerebral toxoplasmosis after BMT

“…1,2 Cerebral toxoplasmosis manifests with focal signs, fever, seizures, headache and altered mental status. 3 A CT scan typically shows multiple hypodense lesions in both hemispheres and basal ganglia with nodular or peripheral enhancement after contrast medium infusion. 3,4 We report a case of fatal disseminated toxoplasmosis infection presenting as a single cerebral hemorrhagic lesion on the CT scan.…”

“…Direct involvement of the vascular endothelium by parasites with mass cell destruction, or vasculitis with extensive vessel wall necrosis, with or without a bleeding disorder, provide a possible explanation for such events. 3,4 Toxoplasmosis infection after BMT usually manifests between the 2nd and 6th month following BMT and is associated with a poor outcome. Only four of the 57 reported cases in the literature survived.…”