Toxoplasmic Encephalitis in Patients with Acquired Immunodeficiency Syndrome <b>—Four Case Reports—</b>

Susumu NAKAZAKI; Naokatsu SAEKI; Seiro ITOH; Katsunobu OSATO; Osamu WATANABE; Norikazu HAMADA; Hiromitsu MITSUHASHI; Hideo SHIN; Ichirou KIUCHI; Chizuko KOBAYASHI; Akihiko YANO; Akira YAMAURA

doi:10.2176/nmc.40.120

Case Reports

Toxoplasmic Encephalitis in Patients with Acquired Immunodeficiency Syndrome

—Four Case Reports—

Susumu NAKAZAKI, Naokatsu SAEKI, Seiro ITOH, Katsunobu OSATO, Osamu WATANABE, Norikazu HAMADA, Hiromitsu MITSUHASHI, Hideo SHIN, Ichirou KIUCHI, Chizuko KOBAYASHI, Akihiko YANO, Akira YAMAURA

Author information

Susumu NAKAZAKI
Department of Neurological Surgery, Chiba University School of Medicine
Naokatsu SAEKI
Department of Neurological Surgery, Chiba University School of Medicine
Seiro ITOH
Department of Neurological Surgery, Chiba University School of Medicine
Katsunobu OSATO
Department of Neurological Surgery, Chiba University School of Medicine
Osamu WATANABE
Department of Neurological Surgery, Chiba University School of Medicine
Norikazu HAMADA
Department of Neurological Surgery, Chiba University School of Medicine
Hiromitsu MITSUHASHI
Department of Neurological Surgery, Chiba University School of Medicine
Hideo SHIN
Department of Neurological Surgery, Chiba University School of Medicine
Ichirou KIUCHI
Department of Neurological Surgery, Chiba University School of Medicine
Chizuko KOBAYASHI
Department of Parasitology, Chiba University School of Medicine
Akihiko YANO
Department of Parasitology, Chiba University School of Medicine
Akira YAMAURA
Department of Neurological Surgery, Chiba University School of Medicine

Keywords: toxoplasmic encephalitis, acquired immunodeficiency syndrome, toxoplasma, metastasis, brain abscess

JOURNAL OPEN ACCESS

2000 Volume 40 Issue 2 Pages 120-123

DOI https://doi.org/10.2176/nmc.40.120

Details

Abstract

Four patients, all males aged 40-64 years, presented with toxoplasmic encephalitis associated with human immunodeficiency virus (HIV) infection manifesting as nonspecific neurological deficits such as epilepsy or hemiparesis. Magnetic resonance imaging showed single or multiple lesions with ring enhancement, mimicking metastatic brain tumor or brain abscess. Marked eosinophilia was noted in three patients. Two patients who received anti-toxoplasma chemotherapy in the early stage had a good outcome. However, the other two patients suffered rapid neurological deterioration and needed decompressive surgery, resulting in a poor outcome. Toxoplasma diffusely infects the whole central nervous system from the early stage. The outcome for patients who needed emergency surgery was poor. Therefore, this rare but increasingly common infectious disease must be considered in the differential diagnosis of a patient with neuroimaging findings similar to those of metastatic tumor or brain abscess. Appropriate chemotherapy should be started immediately after HIV-positive reaction is identified in patients with single or multiple mass lesions with ring enhancement.

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