Clindamycin as single therapy for cerebral toxoplasmosis HIV in the history of sulfa allergy: A Case Report

Abstract

Cerebral toxoplasmosis is an opportunistic infection in HIV with CD4 T-cells below < 200/uL. The aetiology is Toxoplasma gondii. Trimethoprim plus sulfamethoxazole (cotrimoxazole) combined pyrimethamine is the first line for the treatment of cerebral toxoplasmosis in immunodeficiency. The second line for treatment is clindamycin combined pyrimethamine in Indonesia. We reported a 48-year-old woman as diagnosed retroviral infection referred to Wangaya General Hospital, with main complaints of vomiting and severe headache. The blood test showed normal limits except lymphocyte account. IgM antibody for toxoplasmosis raised. Brain computed tomography-scan showed a cystic lesion in right basal ganglia with ring-enhancing surrounding by finger-like oedema. She treated with pyrimethamine and cotrimoxazole. The patient had a reddish rash on the skin with thrombocytopenia during 7-day on treatment suspected sulfa and pyrimethamine adverse side effect. Patient treated clindamycin as single therapy for cerebral toxoplasmosis. Her headache is better within two weeks of admission. Thirty days later the patient was repeated brain-CT scan, and the mass was found to be smaller. Conclusions: Single-therapy with clindamycin in CNS toxoplasmosis showed good outcome in resource-poor setting and history of sulfonamide allergy.