PMID- 37701378
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20230915
IS  - 2532-8689 (Electronic)
IS  - 1124-9390 (Print)
IS  - 1124-9390 (Linking)
VI  - 31
IP  - 3
DP  - 2023
TI  - Toxoplasmosis mimicking CMV chorioretinitis in newly diagnosed PLWH: a case 
      report.
PG  - 404-406
LID - 10.53854/liim-3103-15 [doi]
AB  - BACKGROUND: cytomegalovirus (CMV) retinitis, cerebral and ocular toxoplasmosis 
      are common infections in patients with acquired immunodeficiency syndrome (AIDS). 
      Material and methods: this is a case of a 46-year-old female with previous 
      Kaposi's sarcoma, diagnosed with an HIV infection two weeks prior to 
      hospitalization. Blood test at diagnosis showed a CD4+ count of 77 cell/muL and 
      HIV-RNA 3.758.745 copies/mL. Therapy with bictegravir/emtricitabine/tenofovir 
      alafenamide fumarate was started and clinical, viroimmunological and 
      microbiological investigations were performed. RESULTS: the patient went to our 
      hospital for the onset of left occipito-parietal headache and blurred vision. 
      Brain CT and MRI were performed which did not show focal lesions or vascular 
      alterations. Syphilis serology was negative, Toxoplasma gondii serology showed 
      positive IgG and negative IgM, serum CMV-DNA was 31.184 IU/mL. Eye fundus 
      evidenced intraretinal hemorrhages, fluorescein angiography and computed optical 
      tomography documented cottony exudates, retinal hemorrhages and vitreous 
      involvement. Therapy with valganciclovir was initiated for suspicion of CMV 
      retinitis. About a month later, the patient reported blurred vision for which she 
      was re-admitted. Ocular fundus showed a cottony lesion near the macula. Molecular 
      test on vitreous body was positive for Toxoplasma gondii, while on cerebrospinal 
      fluid it was negative; in addition, an MRI of the brain with contrast medium was 
      performed which showed an area of altered hyperintense signal compatible with a 
      diagnosis of Toxoplasma gondii uveitis and neurotoxoplasmosis. Therapy with 
      pyrimethamine and clindamycin (allergy for sulfonamide reported by the patient) 
      was started. Allergy counseling was performed with the execution of allergy tests 
      (patch test) with negative result; therefore the administration of clindamycin 
      was replaced with sulfadiazine. A month following the start of anti-toxoplasma 
      therapy, there was a clinical and radiological improvement. CONCLUSIONS: despite 
      progressive developments in the management of PLWH, in this case two different 
      kind of opportunistic infection are found in a late-presenter patient. In 
      particular, two aspects can be highlighted. The first one is that, in the setting 
      of an highly impaired immune system, clinical presentation can be deceptive and 
      more than one opportunistic infection can be observed together in the same 
      patient. The second aspect is that after starting antiretroviral therapy, a rapid 
      improvement of viro-immunologic parameters has been documented, probably leading 
      to an immune reconstitution inflammatory syndrome (IRIS).
FAU - Lamanna, Francesco
AU  - Lamanna F
AD  - Dipartimento di Sicurezza e Bioetica - Sezione di Malattie Infettive, Universita 
      Cattolica del Sacro Cuore, Rome, Italy.
FAU - Passerotto, Rosa Anna
AU  - Passerotto RA
AD  - Dipartimento di Sicurezza e Bioetica - Sezione di Malattie Infettive, Universita 
      Cattolica del Sacro Cuore, Rome, Italy.
FAU - Carbone, Andrea
AU  - Carbone A
AD  - Dipartimento di Sicurezza e Bioetica - Sezione di Malattie Infettive, Universita 
      Cattolica del Sacro Cuore, Rome, Italy.
FAU - Steiner, Rebecca Jo
AU  - Steiner RJ
AD  - Dipartimento di Sicurezza e Bioetica - Sezione di Malattie Infettive, Universita 
      Cattolica del Sacro Cuore, Rome, Italy.
FAU - Iannone, Valentina
AU  - Iannone V
AD  - Dipartimento di Sicurezza e Bioetica - Sezione di Malattie Infettive, Universita 
      Cattolica del Sacro Cuore, Rome, Italy.
FAU - Salvo, Pierluigi Francesco
AU  - Salvo PF
AD  - Dipartimento di Sicurezza e Bioetica - Sezione di Malattie Infettive, Universita 
      Cattolica del Sacro Cuore, Rome, Italy.
FAU - Ciccullo, Arturo
AU  - Ciccullo A
AD  - Infectious Diseases Unit, San Salvatore Hospital, L'Aquila, Italy.
FAU - Baldin, Gianmaria
AU  - Baldin G
AD  - Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico 
      Universitario Agostino Gemelli IRCCS, Rome, Italy.
FAU - Borghetti, Alberto
AU  - Borghetti A
AD  - Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico 
      Universitario Agostino Gemelli IRCCS, Rome, Italy.
FAU - Dusina, Alex
AU  - Dusina A
AD  - Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico 
      Universitario Agostino Gemelli IRCCS, Rome, Italy.
LA  - eng
PT  - Case Reports
DEP - 20230901
PL  - Italy
TA  - Infez Med
JT  - Le infezioni in medicina
JID - 9613961
PMC - PMC10495061
OTO - NOTNLM
OT  - CMV
OT  - PLWH
OT  - Toxoplasmosis
OT  - chorioretinitis
COIS- Conflicts of interest A.C. received support for travel to meetings from ViiV 
      Healthcare, A.B. received speakers' honoraria from ViiV Healthcare, and fees for 
      attending advisory boards from Janssen-Cilag. S.D.G. was a paid consultant or 
      member of advisory boards for Gilead Sciences, ViiV Healthcare, Janssen-Cilag, 
      Merck Sharp & Dohme and Bristol-Myers Squibb. All other authors: none to declare.
EDAT- 2023/09/13 06:42
MHDA- 2023/09/13 06:43
PMCR- 2023/09/01
CRDT- 2023/09/13 04:04
PHST- 2023/07/15 00:00 [received]
PHST- 2023/07/31 00:00 [accepted]
PHST- 2023/09/13 06:43 [medline]
PHST- 2023/09/13 06:42 [pubmed]
PHST- 2023/09/13 04:04 [entrez]
PHST- 2023/09/01 00:00 [pmc-release]
AID - 1124-9390_31_3_2023_404-406 [pii]
AID - 10.53854/liim-3103-15 [doi]
PST - epublish
SO  - Infez Med. 2023 Sep 1;31(3):404-406. doi: 10.53854/liim-3103-15. eCollection 
      2023.