ACQUIRED CEREBRAL TOXOPLASMOSIS IN AN IMMUNOCOMPETENT CHILD

Background. Postnatally acquired toxoplasmosis is relatively common as an unapparent infection. When there are severe clinical manifestation s such as encephalitis, pneumonia and myocarditis, the patient should be checked for immunocompetence deficiencies. Case report. A two-year old girl living in French Guyana suffered from acute respiratory distr ess due to interstitial pneumonia plus pericarditis that was treated b y closed pericardial aspiration. Palsies of four limbs and chorioretin itis gradually appeared. The CSF protein content was elevated, 1 g/l, but the number of cells was normal. Serologic tests indicated a recent toxoplasma infection; she was given sulfadoxine, pyrimethamine and sp iramycin. Her neurologic condition and the persistent antibodies, indi cating active disease, led to her transfer to our Department 3 months after the onset of the disease. The CSF contained 47 cells/mm3 and 0.8 g/l proteins. Measurement of both IgM and IgG classes of toxoplasma a ntibodies showed persistent high titers in the blood and CSF The CT sc an showed numerous calcifications in the brain and hypodense areas in the frontal and parietal lobes. The MRI showed extensive changes. The severity of the disease in this girl led us to study her immune system . It was normal. The girl was given 6-week treatments with pyrimethami ne-sulfadiazine for 2 years. This treatment stabilized the disease, bu t her titers of toxoplasma antibodies remained high. Conclusion. The i nitial clinical presentation of the disease in this patient and persis tent high titers of toxoplasma antibodies, especially of the IgM class , argue against the possibility of congenital toxoplasmosis and favor the diagnosis of acquired disease in a patient who has no immune defic iency.