Abstract
In both the post and pre combination antiretroviral therapy (cART) era, Pneumocystis jirovecii and Toxoplasma gondii remain common opportunistic infectious agents. The common manifestations are pneumonia for P. jirovecii and brain abscess for T. gondii. Nevertheless, co-infection remains rare, and pulmonary toxoplasmosis is scarce, or may be underestimated because of its similarity with Pneumocystis jirovecii pneumonia. We reported an uncommon case of an AIDS patient (6 CD4 + T cells/mm3) with both pulmonary and cerebral toxoplasmosis associated with pneumocystis pneumonia. The patient presented with general weakness, fever and dyspnea. Pulmonary toxoplasmosis and pneumocystis were confirmed by microscopic examination and DNA detection in the bronchoalveolar lavage. Computed tomography imaging of the brain revealed a single characteristic cerebral toxoplasmosis lesion of the left capsular area. He was successful treated by trimethoprim/sulfamethoxaxole in conjunction with an early reintroduction of cART, and without IRIS development. During a 3-year follow-up, HIV viral load remained undetectable, and the patient did not relapse for toxoplasmosis or Pneumocystis pneumonia.
Highlights
In the course of HIV infection, the progressive destruction of CD4 + T cells in the absence of control of viral replication leads, over time, to an increased risk of opportunistic infection
The reference treatment for cerebral and pulmonary toxoplasmosis is a combination of pyrimethamine and sulfadiazine, which is systematically combined with folinic acid to prevent the myelotoxicity of pyrimethamine [5]
We report a case of an AIDS patient with both pulmonary and cerebral toxoplasmosis associated with pneumocystis pneumonia, treated by TMP-SMX
Summary
In the course of HIV infection, the progressive destruction of CD4 + T cells in the absence of control of viral replication leads, over time, to an increased risk of opportunistic infection. The first-line agent for the treatment of PCP is trimethoprim/sulfamethoxaxole (TMP-SMX) (or co-trimoxazole) [1]. The reference treatment for cerebral and pulmonary toxoplasmosis is a combination of pyrimethamine and sulfadiazine, which is systematically combined with folinic acid to prevent the myelotoxicity of pyrimethamine [5]. (ii) pyrimethamine combinations with clindamycin, atovaquone or azithromycin, or (iii) atovaquone plus sulfadiazine [6]. Diseases 2017, 5, 35; doi:10.3390/diseases5040035 www.mdpi.com/journal/diseases atovaquone or azithromycin, or (iii) atovaquone plus sulfadiazine [6]. We report a case of an AIDS patient with both pulmonary and cerebral toxoplasmosis associated with pneumocystis pneumonia, treated by TMP-SMX
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