Article type: Case Report
Article
title: Rhombencephalitis
secondary to toxoplasma gondii infection: case report and literature review
Journal: Acta
Medica International
Year: 2020
Authors: Jamir Pitton Rissardo, Ana Letícia Fornari
Caprara, Juliana Oliveira Freitas Silveira
E-mail: jamirrissardo@gmail.com
ABSTRACT
Immunocompetent
(IC) individuals with primary toxoplasmosis are usually asymptomatic. However,
in some IC, toxoplasmosis can present with brainstem encephalitis. We report an
adult female patient with headache associated with worsening coordination. Physical
examination showed bilateral, symmetrical, and nontender cervical
lymphadenopathy. Toxoplasmosis immunoglobulin G (IgG) and IgM were high, and
the IgG antibody avidity pattern was low. The cerebrospinal fluid analysis was
requested that revealed a positive polymerase chain reaction results for
toxoplasmosis. A brain magnetic resonance imaging (MRI) showed a T1-hypointense
left pontine lesion. Pyrimethamine and sulfadiazine were started. After 1
month, the patient had full recovery. Four months after, the individual was
admitted due to progressive abnormal eye movements and tremor. Her neurological
examinations showed ocular myoclonus and Holmes tremor. A second brain MRI
showed hypertrophy of the ipsilateral inferior olivary nucleus. In the
follow-up, her symptoms decreased mildly. The tremor was managed with
clonazepam and levodopa. Furthermore, immune suppression investigation was
negative.
Keywords: Encephalitis, myoclonus, toxoplasmosis, tremor
Full text available at:
DOI
10.4103/ami.ami_78_19
Citation
Rissardo JP, Caprara AL, Silveira JO. Rhombencephalitis secondary to toxoplasma gondii infection: case report and literature review. Acta Med Int 2020;7:51-4
