Division of Infectious Diseases, Department of Internal Medicine, University General Hospital of Patras, 26504, Patras, Greece.
Department of Microbiology, University General Hospital of Patras, 26504, Patras, Greece.
Infection. 2015 Oct;43(5):589-93. doi: 10.1007/s15010-015-0730-9. Epub 2015 Jan 27.
Toxoplasmosis is the most common opportunistic infection of the central nervous system in immunosupressed patients. It is usually presented as a space-occupying lesion detected by cerebral computerized tomography or magnetic resonance imaging. The diffuse form of the disease (diffuse toxoplasmic meningoencephalitis) lacks the characteristic cerebral radiologic findings rendering pre-mortem diagnosis much more difficult. Herein, we describe a case of toxoplasmic menincoencephalitis, without evidence of cerebral space-occupying lesions, in a patient with ulcerative colitis under combined therapy with systemic glucocorticoids and azathioprine. Diagnosis was based on microscopic examination of cerebrospinal fluid (CSF) for the parasite, whereas, RT-PCR for Toxoplasma gondii was negative. Taking into consideration the limitations of molecular methods, investigation of the etiology of meningeal involvement in patients under immunosuppressive therapy presenting positive serology of previous T. gondii infection, should include microscopic examination of CSF for parasite presence.
弓形体病是免疫抑制患者中枢神经系统最常见的机会性感染。它通常表现为占位性病变，通过脑部计算机断层扫描或磁共振成像检测到。疾病的弥漫性形式（弥漫性弓形体脑膜脑炎）缺乏特征性的脑部放射学发现，使得生前诊断更加困难。在此，我们描述了一例溃疡性结肠炎患者在接受全身糖皮质激素和硫唑嘌呤联合治疗期间发生的无占位性病变的弓形体脑膜脑炎。诊断基于对脑脊液（CSF）中寄生虫的显微镜检查，而对刚地弓形虫的 RT-PCR 为阴性。考虑到分子方法的局限性，对接受免疫抑制治疗且既往刚地弓形虫感染血清学阳性的脑膜受累患者的病因进行研究时，应包括对 CSF 中寄生虫存在的显微镜检查。
