Abstract
Cerebral toxoplasmosis is a life-threatening infection most commonly found in immunocompromised hosts such as acquired immunodeficiency syndrome (AIDS) or transplant patients. However, it is not known to affect patients with chronic inflammatory disorders on immunosuppressive therapy. We describe the case of a 70-year-old female with rheumatoid arthritis (RA) on chronic therapy with methotrexate and infliximab, who presented to the hospital after two weeks of right-sided weakness. Imaging revealed bilateral ring-enhancing lesions in the basal ganglia (left greater than right). A diagnosis of cerebral toxoplasmosis was made on brain biopsy. Apart from the immunosuppressive therapy and owning a cat, she had no other risk factors for developing the infection. The patient's immunosuppressive medications were discontinued, and she was started on high-dose trimethoprim-sulfamethoxazole (TMP-SMX). Upon literature review using PubMed, we found seven other published reports on similar cases of toxoplasmosis in RA patients on immunosuppressive therapy; however, there was a lack of recommendations for diagnosis, treatment, and prophylaxis in this patient population. With the growing use of immunosuppressive therapies in chronic inflammato...Continue Reading
References
Oct 7, 2005·The New England Journal of Medicine·Jeremy D Young, Bradford S McGwire
Apr 24, 2010·Rinshō shinkeigaku = Clinical neurology·Kazuhiro HoriuchiHidenao Sasaki
Apr 12, 2012·Clinical Microbiology Reviews·Florence Robert-Gangneux, Marie-Laure Dardé
Jul 27, 2012·Scandinavian Journal of Infectious Diseases·Geita Saadatnia, Majid Golkar
Jul 9, 2013·Handbook of Clinical Neurology·Sandra K Halonen, Louis M Weiss
Jul 16, 2013·Annals of the Rheumatic Diseases·John W BaddleyJeffrey R Curtis
Nov 6, 2013·Rheumatology·Raffaele NardoneStefan Golaszewski
May 15, 2015·Rheumatology·Joseph M LewisEmmanuel Nsutebu
Jun 2, 2015·Internal Medicine·Swaroopa PulivarthiMurali Krishna Gurram
Jan 13, 2018·Internal Medicine·Jun MatsuuraToshiki Mizuno
Jun 6, 2018·PLoS Neglected Tropical Diseases·Zahra HosseininejadAhmad Daryani
Jul 12, 2019·Journal of Clinical Rheumatology : Practical Reports on Rheumatic & Musculoskeletal Diseases·Andrew WalkdenLaura R Steeples
Jan 23, 2020·Der Internist·M BachC Baerwald