Document 0243
 DOCN  M9590243
 TI    Disseminated primary toxoplasmosis in HIV.
 DT    9509
 AU    Kelly M; Jones P; Clezy K; Lloyd A; Dept. Infectious Diseases, Prince
       Henry Hospital, Little Bay,; Sydney.
 SO    Annu Conf Australas Soc HIV Med. 1994 Nov 3-6;6:281 (unnumbered poster).
       Unique Identifier : AIDSLINE ASHM6/95291856
 AB    Toxoplasmosis usually manifests as a localised cerebral abscess in
       patients with profound immunodeficiency in HIV infection. We report a
       case of primary disseminated toxoplasmosis occurring in an HIV infected
       patient with moderate immunodeficiency. A 33 year old previously
       asymptomatic vegetarian homosexual HIV infected male with a CD4 cell
       count of 130/ul (9%) presented with a three week history of fevers,
       sweats, nonproductive cough and muscle pains. He was non-compliant with
       dapsone prophylactic therapy. A presumptive diagnosis of PCP was made on
       the basis of tachypnoea, bilateral crepitations at lung bases, hypoxia
       and bilateral infiltrate on CXR. Intravenous pentamidine was commenced.
       After initial stabilisation, his condition deteriorated with worsening
       respiratory function, renal failure, liver dysfunction, coagulopathy and
       grand-mal seizures. CXR revealed progressive bilateral infiltrates.
       Immunofluorescence for P.C. was negative in induced sputum and
       bronchoalveolar fluid. His condition deteriorated and he succumbed on
       the fourteenth hospital day. All microbiological cultures were negative.
       Serology for mycoplasma, influenza, and Legionella was negative. At
       autospy disseminated toxoplasmosis was documented. Lung, brain, liver
       and heart were involved. Toxoplasma serology, taken some years earlier
       and at the time of this illness, was negative. Serum LDH was normal but
       serum CPK was markedly elevated. Disseminated toxoplasmosis is rare in
       HIV infection. It usually presents as a multiorgan failure syndrome.
       Diagnosis is difficult and mortality high. Disseminated toxoplasmosis
       should be considered in any HIV infected person presenting with
       undiagnosed sepsis.
 DE    Adult  AIDS-Related Opportunistic Infections/*DIAGNOSIS/IMMUNOLOGY/
       PATHOLOGY  Brain/PATHOLOGY  Case Report  CD4 Lymphocyte Count  Human
       Liver/PATHOLOGY  Lung/PATHOLOGY  Male  Myocardium/PATHOLOGY
       Toxoplasmosis/*DIAGNOSIS/IMMUNOLOGY/PATHOLOGY  MEETING ABSTRACT

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