GASTRIC TOXOPLASMOSIS IN ACQUIRED-IMMUNODEFICIENCY-SYNDROME - ANTEMORTEM DIAGNOSIS WITH HISTOPATHOLOGIC CHARACTERIZATION

Gastrointestinal symptoms attributable to Toxoplasma gondii infection are distinctly unusual, and antemortem diagnosis of gastrointestinal i nvolvement is rarely documented, particularly in the absence of cerebr al manifestations or disseminated disease, This case report describes a rare example of T. gondii infection of the stomach diagnosed antemor tem in a 22-year-old Haitian woman with acquired immunodeficiency synd rome (AIDS) who presented with fever and abdominal pain, An abdominal computerized tomographic scan showed thickened gastric walls. Endoscop y showed diffusely thickened gastric folds and a fundic ulcer along th e greater curvature. Light and electron-microscopic examination of gas tric mucosal biopsy specimens showed active Toxoplasma infection with necrosis and intracellular trophozoites within the gastric epithelium, smooth muscle cells, macrophages, and endothelial cells. Both true cy sts and pseudocysts were seen, Disseminated disease was documented by the growth of T. gondii in a tissue culture from a venous blood sample , It is concluded that some patients with AIDS, particularly those fro m areas endemic for Toxoplasma infection, can manifest disseminated di sease in unusual locations such as the gastrointestinal tract, Documen tation of active T. gondii infection based on tissue cultures of venou s blood or on biopsy specimens of symptomatic extracerebral sites can lead to a rapid diagnosis of toxoplasmosis, a treatable disease.