Treatment of toxoplasma brain abscess with clindamycin and sulfadiazine in an AIDS patient with concurrent atypical pneumocystis carinii pneumonia

Hung Chin Tsai, Susan Shin Jung Lee, Hsi Hsun Lin, Wei Ru Lin, Yao Shen Chen, Chun Kai Huang, Yung Ching Liu, Eng Rin Chen

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Toxoplasmosis is the most common opportunistic infection of the central nervous system in patients with AIDS. The standard treatment for toxoplasmic encephalitis is pyrimethamine and sulfadiazine. There have been few reports of concurrent Toxoplasma brain abscess and cavitary Pneumocystis carinii pneumonia (PCP) in Taiwan. We report the case of a 26-year-old homosexual man with coexisting infection with Toxoplasma gondii and P. carinii who was succesfully treated for brain abscess with clindamycin and sulfadiazine. The cavitary lung lesions, initially diagnosed as pulmonary tuberculosis, were proved to be PCP by lung biopsy. HIV infection and syphilis had been diagnosed 1 year before admission. He presented with general weakness, ataxia, nausea, blurred vision and fever for 2 weeks. Magnetic resonance imaging of the brain revealed multiple ring-enhanced lesions over the cerebrum and cerebellum. Chest roentgenography showed a 3-cm lesion with cavitation over the right upper lung field. Diagnostic computerized tomography-guided lung biopsy revealed P. carinii cysts. Clindamycin, sulfadiazine and trimethoprim (TMP)-sulfamethoxazole (20 mg/kg/day TMP) were given with good response. His CD4 count rose from 40 to 280/μL 4 months later. All antibiotics were discontinued after 4.5 months due to the development of a skin rash. He was well at follow-up 1 year later. This case suggests that the combination of clindamycin and sulfadiazine is an effective treatment for Toxoplasma brain abscess and highlights the importance of diagnostic lung biopsy for cavitary lung lesions, particularly in a region endemic for tuberculosis.

Original languageEnglish
Pages (from-to)646-649
Number of pages4
JournalJournal of the Formosan Medical Association = Taiwan yi zhi
Volume101
Issue number9
Publication statusPublished - Sep 1 2002
Externally publishedYes

Keywords

  • Clindamycin
  • Pneumocystis carinii pneumonia
  • Sulfadiazine
  • Toxoplasma brain abscess

ASJC Scopus subject areas

  • Medicine(all)

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