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.
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