Fever, Hemiparesis and Hyponatraemia in a 63-year-old. HIV, another Great Masquerader?

  • David Agius Department of Medicine, Mater Dei Hospital, Msida, Malta
  • Jonathan Gauci Department of Medicine, Mater Dei Hospital, Msida, Malta
  • Lars Aakeroy Department of Medicine, Mater Dei Hospital, Msida, Malta
  • Brendan Caruana Montaldo Department of Medicine, Mater Dei Hospital, Msida, Malta

Keywords

Toxoplasmosis, HIV, Acquired Immunodeficiency Syndrome, Inappropriate ADH Syndrome

Abstract

The authors describe the unusual case of a 63-year-old patient who was referred with fever and lethargy, and was found to be hyponatraemic.
The patient subsequently developed hemiparesis, and neuroradiology showed several space-occupying brain lesions. The cause was later
identified as cerebral toxoplasmosis in undiagnosed Acquired Immunodeficiency Syndrome (AIDS).

Author Biographies

David Agius ,
Department of Medicine, Mater Dei Hospital, Msida, Malta FY2,Departments of medicine and surgery, Mater Dei Hospital, Malta

VIEW THE ENTIRE ARTICLE

References

  • Moolasart, P., Giardia lamblia in AIDS patients with diarrhea. J Med Assoc Thai. 1999;82:654–9.
  • Meamar AR, Rezaian M, Mohraz M, Zahabiun F, Hadighi R, Kia EB. A Comparative Analysis of Intestinal Parasitic Infections between HIV+/AIDS Patients and Non-HIV Infected Individuals. Iranian J Parasitol;2007;2:1-6.
  • Berger J R, Moskowitz L, Fischl M, Kelley R E. Neurologic disease as the presenting manifestation of acquired immunodeficiency syndrome. South Med J 1987;80:683–6.
  • Ho Y, Sun H, Chen M, Hsieh S, Sheng W, Chang S. Clinical presentation and outcome of toxoplasmic encephalitis in patients with human immunodeficiency virus type 1 infection. J Microbiol Immunol Infect 2008;41:386-392.
  • Osunkalu V, Akanmu SA, Ofomah NJ, Onyiaorah IV, Adediran AA, Akinde RO, Onwuezobe IA. Seroprevalence of Toxoplasma gondii IgG antibody in HIV-infected patients at the Lagos University Teaching Hospital. HIV/AIDS (Auckland, N.Z.) 2011;3:101–5.
  • Skiest DJ, Erdman W, Chang WE, Oz OK, Ware A, Fleckenstein J. SPECT thallium-201 combined with Toxoplasma serology for the presumptive diagnosis of focal central nervous system mass lesions in patients with AIDS. J Infect 2000;40:274–81.
  • Porter SB, Sande MA. Toxoplasmosis of the central nervous system in the acquired immunodeficiency syndrome. NEJM 1992;327:1643–8.
  • Mathews C, Barba D, Fullerton SC. Early biopsy versus empiric treatment with delayed biopsy of non-responders in suspected HIV-associated cerebral toxoplasmosis: a decision analysis. AIDS 1995;9:1243-1250. 10.1097/00002030-199511000-00005.
  • Dedicoat M, Livesley N. Management of toxoplasmic encephalitis in HIV-infected adults (with an emphasis on resource-poor settings). Cochrane Database Syst Rev 2006;19:CD005420.
  • Sonneville R, Schmidt M, Messika J, Ait Hssain A, da Silva D, et al. Neurologic outcomes and adjunctive steroids in HIV patients with severe cerebral toxoplasmosis. Neurology 2012;79:1762-6.
  • Published: 2015-07-28

    Issue: Vol. 2 No. 5 (2015) (view)

    Section: Articles

    How to cite:
    1.
    Agius D, Gauci J, Aakeroy L, Caruana Montaldo B. Fever, Hemiparesis and Hyponatraemia in a 63-year-old. HIV, another Great Masquerader?. EJCRIM 2015;2 doi:10.12890/000_232.

    Most read articles by the same author(s)