A CASE WHO DEVELOPED TOXOPLASMA ENCEPHALITIS AS THE INITIAL MANIFESTATION OF AIDS

Abstract

A 31 year-old Brazilian male complained of paresthesia in the right hand and then developed right hemiplegia and left cranial nerve III paresis. Magnetic resonance imaging brain scanning revealed a 3 cm diameter mass lesion occupying the left midbrain to thalamus. Since the mass was indistinguishable from a primary CNS lymphoma, the patient underwent stereotactic brain biopsy and was diagnosed as toxoplasma encephalitis by an immunostaining technique. He was treated by 3 combined therapy with pyrimethamine, clindamicin and salfamonomethoxine. The mass was remarkably diminished in MRI and his leval of consciousness improved although his neurological symptoms had not changed. About 13 months later, he developed systemic convulsions and sudden apnea, suggesting brain herniation. He died even though treatment with pyrimethamine had been continued.