Abbasi Fard Salman, Khajeh Ali, Khosravi Alireza, Mirshekar Afsaneh, Masoumi Safoora, Tabasi Farhad, Hassanzadeh Tania, Mortazavi Martin M
Department of Neurosurgery, National Skull Base Foundation, Thousand Oaks, CA, USA.
Pediatric Department, Zahedan University of Medical Sciences, Zahedan, Iran.
Am J Case Rep. 2020 Jan 26;21:e919624. doi: 10.12659/AJCR.919624.
BACKGROUND One of the most common causes of central nervous system (CNS) opportunistic infections in immunocompromised patients is toxoplasmosis. It can cause focal or disseminated brain lesions leading to neurological deficit, coma, and death. Prompt management with optimal antibiotics is vital. However, the diagnosis of cerebral toxoplasmosis is challenging in infected individuals with human immunodeficiency virus (HIV). The possible diagnosis is based on clinical presentation, imaging, and specific serologic investigations. The diagnosis can be confirmed by histopathological examination and/or by finding nucleic material in the spinal cerebrospinal fluid (CSF) examination. CASE REPORT We present a review of the literature with a rare illustrative case of diffuse CNS toxoplasmosis as the first manifestation of HIV infection in a young patient. Brain MRI showed diffuse, ring-enhancing lesions, and significant midline shift. Decompressive hemicraniectomy for control of intracranial pressure and anti-infectious therapy were performed. CONCLUSIONS This should raise awareness that cerebral toxoplasmosis can occur in pediatric patients with HIV infection, and, more importantly, as the first manifestation of AIDS. Although the prognosis is often poor, early diagnosis and immediate treatment of this life-threatening opportunistic infection can improve outcomes.
免疫功能低下患者中枢神经系统（CNS）机会性感染最常见的原因之一是弓形虫病。它可导致局灶性或播散性脑病变，进而引起神经功能缺损、昏迷和死亡。采用最佳抗生素进行及时治疗至关重要。然而，对于感染人类免疫缺陷病毒（HIV）的个体，脑弓形虫病的诊断具有挑战性。可能的诊断基于临床表现影像学和特定的血清学检查。诊断可通过组织病理学检查和/或在脑脊液（CSF）检查中发现核酸物质来证实。病例报告：我们回顾了文献，并报告一例罕见的说明性病例，一名年轻患者以弥漫性中枢神经系统弓形虫病作为HIV感染的首发表现。脑部磁共振成像（MRI）显示弥漫性环形强化病变和明显的中线移位。进行了减压性颅骨切除术以控制颅内压并给予抗感染治疗。结论：这应提高人们的认识，即脑弓形虫病可发生于HIV感染的儿科患者，更重要的是，可作为艾滋病的首发表现。尽管预后通常较差，但对这种危及生命的机会性感染进行早期诊断和立即治疗可改善结局。
