ABM University trust, Singleton hospital, Swansea, UK.
Int J Gen Med. 2009 Jul 30;2:73-5. doi: 10.2147/ijgm.s4826.
A male intravenous drug abuser who was infected with hepatitis B and C, presented with a slowly progressive hemiplegia. Contrast enhanced computerized tomography of the head showed a solitary ring-enhanced mass with surrounding edema. Clinically brain tumor was suspected but a brain biopsy confirmed cerebral toxoplasmosis. An HIV test was not considered until the result of brain biopsy. He also had lymphopenia and positive serum toxoplasma antibody. His subsequent HIV test was positive. He deteriorated after a brain biopsy. Empirical antitoxoplasma treatment is recommended in HIV-positive patients with ring-enhanced lesions with surrounding edema and with positive toxoplasma serology. Cerebral toxoplasmosis is still the commonest cerebral opportunistic infection in HIV-infected patients even though the incidence has declined with the use of antiretroviral therapy. It is often diagnosed in those patients as an initial presentation of HIV infection or in those who failed to attend for disease monitoring. Clinical features and differential diagnosis of cerebral toxoplasmosis in immunocompromised patients are discussed.
一位感染乙型肝炎和丙型肝炎的男性静脉药物滥用者，出现进行性偏瘫。头部增强计算机断层扫描显示单个环形增强肿块伴周围水肿。临床怀疑脑肿瘤，但脑活检证实为脑弓形虫病。直到脑活检结果出来后，才考虑进行 HIV 检测。他还伴有淋巴细胞减少和血清弓形虫抗体阳性。他随后的 HIV 检测呈阳性。脑活检后他的病情恶化了。对于伴有周围水肿和弓形虫血清学阳性的环形增强病变的 HIV 阳性患者，建议进行经验性抗弓形虫治疗。即使随着抗逆转录病毒治疗的应用，发病率有所下降，弓形虫病仍然是 HIV 感染患者中最常见的脑机会性感染。它经常在那些作为 HIV 感染初始表现的患者或那些未能进行疾病监测的患者中被诊断出来。讨论了免疫功能低下患者中弓形虫病的临床特征和鉴别诊断。
