Document 1202
 DOCN  M9591202
 TI    Cerebral toxoplasmosis in childhood and adult HIV infection treated with
       1-4 hydroxynaphthoquinone and rapid desensitization with pyrimethamine.
 DT    9509
 AU    Bouboulis DA; Rubinstein A; Shliozberg J; Madden J; Frieri M; Department
       of Pediatrics, Microbiology, & Immunology, Albert; Einstein College of
       Medicine, New York, USA.
 SO    Ann Allergy Asthma Immunol. 1995 Jun;74(6):491-4. Unique Identifier :
       AIDSLINE MED/95308314
 AB    BACKGROUND: We describe a child and an adult infected with the human
       immunodeficiency virus (HIV) who developed cerebral lesions consistent
       with toxoplasmosis. A biopsy in the child and IgG ELISA in both patients
       confirmed the diagnosis of Toxoplasma gondii. The patients were
       initially treated with pyrimethamine, however, computerized tomography
       studies (CT scan) revealed progression of a left frontal and
       temporoparietal lesion. Therapy in the child was changed to
       pyrimethamine, clindamycin, and azithromycin. Repeat CT scan showed
       further disease progression and therapy was changed to high-dose
       pyrimethamine (3 mg/kg/d) and azithromycin. A subsequent CT scan
       disclosed further radiologic progression with increasing edema. The
       adult patient developed a maculopapular rash during attempted treatment
       with pyrimethamine. METHODS: Introduction of 2 (trans-4[4 chlorophenol]
       cyclohexy[3-hydroxy-1, 4 naphthoquinone] (HNPQ) an experimental
       antiparasitic compound previously used only in adult HIV clinical
       trials, was instituted in the child and rapid oral desensitization to
       pyrimethamine was initiated in the adult patient. RESULTS: HNPQ resulted
       in resolution of the cerebral lesion in the child and rapid oral
       desensitization to pyrimethamine produced an excellent clinical response
       in the adult. To our knowledge, these are the first cases of childhood
       and adult cerebral toxoplasmosis treated successfully with HNPQ and
       rapid oral desensitization to pyrimethamine. CONCLUSION: HNPQ and
       pyrimethamine desensitization should be considered as alternate modes of
       therapy in patients who become intolerant or fail to respond to
       traditional therapy for toxoplasmosis.
 DE    Adult  Antiprotozoal Agents/*THERAPEUTIC USE  AIDS-Related Opportunistic
       Infections/*COMPLICATIONS/*DRUG  THERAPY  Case Report  Child
       Desensitization, Immunologic  Female  Human  HIV
       Infections/*COMPLICATIONS  Naphthoquinones/*THERAPEUTIC USE
       Pyrimethamine/*IMMUNOLOGY  Support, U.S. Gov't, P.H.S.  Toxoplasmosis,
       Cerebral/*COMPLICATIONS/*DRUG THERAPY  JOURNAL ARTICLE

       SOURCE: National Library of Medicine.  NOTICE: This material may be
       protected by Copyright Law (Title 17, U.S.Code).