Emeka E U, Ogunrin A O, Olubunmi A
Dermatology Unit, Department of Medicine, University of Benin Teaching Hospital, Benin City, Nigeria.
West Afr J Med. 2010 Mar-Apr;29(2):123-6. doi: 10.4314/wajm.v29i2.68208.
Toxoplasma encephalitis is a common presentation of Toxoplasma gondii infection of the central nervous system in the late stage of human immunodeficiency viral (HIV) infection. The definitive diagnosis requires demonstration of toxoplasma in brain tissue. However, neuroradiologic demonstration (using Computed Tomography or Magnetic Resonance Imaging) of ring-enhanced multiple or single focal intracranial lesions in the presence of immunosuppression and prompt response to presumptive therapy are diagnostic in the absence of histological facilities. The rarity of toxoplasma lesions in the cerebellum prompts a high index of clinical suspicion and early institution of presumptive therapy in poor resource sub-Saharan countries like Nigeria.
To illustrate the presentation of recurrent cerebellar toxoplasmosis in a patient with HIV/AIDS.
A 34-year-old previously diagnosed HIV/AIDS male patient with right-sided cerebellar signs on neurological evaluation and a ring-enhancing lesion in the right cerebellar hemisphere on CT brain scan. An initial response to antitoxoplasmic drugs was short-lived due to poor compliance resulting in recurrence of lesion.
On initial evaluation a diagnosis of cerebellar space occupying lesion in a patient with HIV/AIDS was made. He responded to treatment with clindamycin, pyremethamine and pyridoxine. Following default in treatment for three months he represented with florid cerebellar features, but again responded rapidly to treatment.
Cerebellar toxoplasmosis is an infrequent complication of HIV/AIDS. Early diagnosis with neuro-imaging techniques and prompt institution of appropriate therapy results in remarkable improvement.
弓形虫性脑炎是人类免疫缺陷病毒（HIV）感染晚期中枢神经系统弓形虫感染的常见表现。确诊需要在脑组织中发现弓形虫。然而，在没有组织学检查条件的情况下，神经放射学检查（使用计算机断层扫描或磁共振成像）显示在免疫抑制情况下颅内出现多发或单发环形强化局灶性病变，且对经验性治疗迅速起效，可作为诊断依据。在撒哈拉以南资源匮乏的国家，如尼日利亚，小脑弓形虫病变罕见，这就需要高度的临床怀疑并尽早开始经验性治疗。
举例说明一名HIV/AIDS患者复发性小脑弓形虫病的表现。
一名34岁男性患者，先前被诊断为HIV/AIDS，神经系统评估有右侧小脑体征，脑部CT扫描显示右侧小脑半球有一个环形强化病变。由于依从性差，对抗弓形虫药物的初始反应短暂，导致病变复发。
初始评估时诊断为一名HIV/AIDS患者患有小脑占位性病变。他对克林霉素、乙胺嘧啶和吡哆醇治疗有反应。在停药三个月后，他再次出现明显的小脑症状，但再次迅速对治疗产生反应。
小脑弓形虫病是HIV/AIDS的一种罕见并发症。通过神经影像学技术早期诊断并及时给予适当治疗可显著改善病情。
