J Korean Neurosurg Soc.  2012 May;51(5):316-319. 10.3340/jkns.2012.51.5.316.

Cerebral Toxoplasmosis Combined with Disseminated Tuberculosis

• Hwang EH
• Ahn PG
• Lee DM
• Kim HS

• KMID: 2066935
• DOI: http://doi.org/10.3340/jkns.2012.51.5.316

Abstract

A 24-year-old man presented with mental change, fever, abdominal pain, tenderness and palpable mass on the lower abdomen. He was a non-Korean engineer and did not accompany a legal guardian, so medical history taking was difficult due to his mental status. Brain magnetic resonance imaging showed multiple rim-enhanced lesions of the brain, and abdominal computed tomography showed huge paraspinal abscess. Chest X-ray and computed tomography showed poorly defined nodular opacities. We initially thought that this patient was infected with toxoplasmosis with typical cerebral image finding and immunoglobulin laboratory finding of cerebrospinal fluid and serum study. The abdominal abscess was confirmed as tuberculosis through the pathologic finding of caseous necrosis. We used anti-tuberculosis medication and anti-toxoplasmosis medication for almost 4 months, and then his clinical state and radiological findings were considerably improved.

Keyword

Cerebral toxoplasmosis; Tuberculosis; Toxoplasmic encephalitis; Abdominal abscess

MeSH Terms

Abdomen
Abdominal Abscess
Abdominal Pain
Abscess
Brain
Fever
Humans
Immunoglobulins
Legal Guardians
Magnetic Resonance Imaging
Medical History Taking
Necrosis
Thorax
Toxoplasmosis
Toxoplasmosis, Cerebral
Tuberculosis
Young Adult
Immunoglobulins

Figure

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  Fig. 1 A sign ptosis of the right eye.

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  Fig. 2 Magnetic resonance imaging at admission shows a multiple rim-enhanced lesion around the whole brain and leptomeningeal seeding.

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  Fig. 3 Initial chest X-ray (A) and chest computed tomography (B) show bilateral and poorly defined nodular opacities. This finding suggests pulmonary tuberculosis or toxoplasmosis.

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  Fig. 4 Huge paraspinal abscess are shown on computed tomography (A and B) and magnetic resonance images (C and D). The abscess caused bony erosion and extended into the epidural space.

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  Fig. 5 Three months after medication therapy, the number of multiple nodules on brain magnetic resonance images decreased (A and B). The size of abdominal abscess considerably decreased on lumbar spine magnetic resonance images (C) and the finding of chest X-ray is improved (D).

Reference

1. Beazley DM, Egerman RS. Toxoplasmosis. Semin Perinatol. 1998; 22:332–338. PMID: 9738998.

2. Caiaffa WT, Chiari CA, Figueiredo AR, Orefice F, Antunes CM. Toxoplasmosis and mental retardation--report of a case-control study. Mem Inst Oswaldo Cruz. 1993; 88:253–261. PMID: 8107587.

3. Carruthers VB, Suzuki Y. Effects of Toxoplasma gondii infection on the brain. Schizophr Bull. 2007; 33:745–751. PMID: 17322557.

4. Cota GF, Assad EC, Christo PP, Giannetti AV, Santos Filho JA, Xavier MA. Ventriculitis : a rare case of primary cerebral toxoplasmosis in AIDS patient and literature review. Braz J Infect Dis. 2008; 12:101–104. PMID: 18553025.

5. Frenkel JK. Pathology and pathogenesis of congenital toxoplasmosis. Bull N Y Acad Med. 1974; 50:182–191. PMID: 4592096.

6. Gleason TH, Hamlin WB. Disseminated toxoplasmosis in the compromised host. A report of five cases. Arch Intern Med. 1974; 134:1059–1062. PMID: 4215377.

7. Holliman RE. Toxoplasmosis, behaviour and personality. J Infect. 1997; 35:105–110. PMID: 9354342.

8. Kumar GG, Mahadevan A, Guruprasad AS, Kovoor JM, Satishchandra P, Nath A, et al. Eccentric target sign in cerebral toxoplasmosis : neuropathological correlate to the imaging feature. J Magn Reson Imaging. 2010; 31:1469–1472. PMID: 20512900.

9. Oksenhendler E, Cadranel J, Sarfati C, Katlama C, Datry A, Marche C, et al. Toxoplasma gondii pneumonia in patients with the acquired immunodeficiency syndrome. Am J Med. 1990; 88:18N–21N.

10. Sugane K, Takamoto M, Nakayama K, Tada T, Yuasa T, Kurokawa K. Diagnosis of Toxoplasma meningoencephalitis in a non-AIDS patient using PCR. J Infect. 2001; 42:159–160. PMID: 11531325.

11. Vietzke WM, Gelderman AH, Grimley PM, Valsamis MP. Toxoplasmosis complicating malignancy. Experience at the National Cancer Institute. Cancer. 1968; 21:816–827. PMID: 4296934.