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A Recurrent Case of Toxoplasmic Encephalitis Accompanied by Primary Central Nervous System Lymphoma
1)Department of Infectious Diseases, Tokyo Metropolitan Komagome Hospital, 2)Department of Infection Prevention and Control, Tokyo Metropolitan Komagome Hospital, 3)Department of Infection and Host Defense, Graduate School of Medicine, Chiba University, 4)Toshima Hospital, Tokyo Metropolitan Health and Medical Treatment Corporation
Takuya WASHINO1), Keishiro YAJIMA1), Kazuaki FUKUSHIMA1), Noritaka SEKIYA2), Kazumi NOROSE3), Atsushi AJISAWA1)4) & Akifumi IMAMURA1)
(Received December 20, 2017)
(Accepted June 5, 2018)
Key words: toxoplasmic encephalitis, primary central nervous system lymphoma(PCNSL), AIDS

In patients with human immunodeficiency virus (HIV) infection, toxoplasmic encephalitis (TE) is a common cause of space-occupying brain lesions, but primary central nervous system lymphoma (PCNSL) can likewise present as a focal brain lesion and has a poor prognosis. Therefore, distinguishing TE from PCNSL is important, but usually difficult. We herein on report a rare case for TE complicated with PCNSL in a patient with HIV infection. He was referred to our hospital with tonic-clonic seizures. He had been treated for TE and HIV infection for 5 years, but he stopped going to the hospital 2 years previously. His CD4-positive cell count was 2/μL and the serum anti-Toxoplasma IgG antibody was positive. Cranial magnetic resonance imaging (MRI) showed a 2.7-cm nodule with the eccentric target sign and surrounding edema in the right parietal lobe. Thallium-201 scintigraphy showed an uptake in the nodule. Both Epstein-Barr virus and Toxoplasma gondii DNAs were detected in the cerebrospinal fluid with the polymerase chain reaction (PCR) technique. Because empiric treatment for TE failed to improve his symptoms, a brain biopsy was performed and showed PCNSL on histopathologic examination and Toxoplasma DNA on PCR. After whole-brain radiation therapy, dexamethasone, and antiretroviral therapy, his symptoms and MRI abnormalities improved. A brain biopsy and Toxoplasma PCR test should be considered in cases with atypical clinical presentation.

[ Kansenshogaku Zasshi 92: 696-700, 2018 ]

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