A 49-year-old male, Peruvian with 10 years of residence in Spain and last trip to his country in 1995, with no history of interest except sexual aggression in 1996, with severe tearing of the anal canal that caused non-toxic transfusion habits.
She consulted for 4-5 stools a day, liquid, without pathological products, about 6 months of evolution, adding fever up to 39oC in the last two months.
Loss of consciousness was 2-3 Kg weight at this time; mild abdominal pain; holocraneal headache.
Anamnesis line by devices without remarkable data.
On physical examination, the patient had a fever of 38.5°C well, neurological auscultation normal cardio-pulmonary auscultation, mild and diffusely painful abdomen normal rectal examination and without signs of peritoneal irritation, coughing cold sputum.
Laboratory data: Globular sedimentation rate (GSR) 35; blood count, blood biochemistry, basic coagulation study, thyroid hormones and normal urine routine.
Anti Hbc and anti HBe positive; HCV, RPR, Rose of Bengala, Ac.
Leishmania, Ag. cryptococci and Mantoux were negative.
CMV antigenemia 70 cells; Ac.
Positive toxoplasma HIV (ELISA and Western Blot).
CD4 96; Viral Load 153,690 copies.
Blood cultures were negative (2 sodas duodenal study); urine cultures were negative for cryptosporidium and microsporidia; enteropathogens and Clostridium difficile toxin were negative; duodenal juice and CMV 2a culture was negative.
Eye fundus showed no evidence of CMV infection.
Imaging tests: chest X-ray, abdominal ultrasound, sentinel lymph node biopsy, and gastrointestinal transit with no notable abnormalities.
Cranial CT showed an intra-axial mass with predominantly annular enhancement after IV contrast, centered on the anterior arm of the internal capsule and significant differential left vasogenic lymph nodes associated with toxoplasmosis.
Treatment with 48 Ganvir IV was started for the treatment of CMV infection, as well as Sulfadiacin and Pirim VO, the treatment with IV corticoids for brain mass started, with disappearance of fever and normalization of fever.
Fourteen days after starting treatment, the patient remained asymptomatic. A head CT scan was repeated, showing a considerable reduction in the size of the lesion, supporting the diagnosis of cerebral toxoplasmosis.
