Document 0957
 DOCN  M9540957
 TI    [Pyrimethamine-sulfadiazine resistant cerebral toxoplasmosis in AIDS]
 DT    9504
 AU    Huber W; Bautz W; Classen M; Schepp W; II. Medizinische Klinik, Klinikum
       rechts der Isar der Technischen; Universitat Munchen.
 SO    Dtsch Med Wochenschr. 1995 Jan 20;120(3):60-4. Unique Identifier :
       AIDSLINE MED/95129392
 AB    A 48-year-old man with known HIV infection for 4 years was admitted with
       a 2-week history of increasing brachio-facial paraesthesiae of the left
       side of the body and pains in the head and neck. Physical examination
       also showed discrete slowing of mental activity and oral candidiasis.
       Toxoplasmosis serology showed a low titre with a borderline IgM titre.
       Cranial computer tomography showed two confluent contrast medium
       concentrating foci in the region of the head of the caudate nucleus and
       the right internal capsule. Because toxoplasmosis encephalitis was
       suspected, treatment was started with sulfadiazine (1 g four times
       daily), pyrimethamine (25 mg four times daily), folic acid (15 mg daily)
       and dexamethasone (8 mg three times daily). After 19 days of treatment
       there was no clinical improvement, and a check CT scan showed worsening
       with increased oedema of the cerebellar medulla, compression of the
       lateral ventricles and a mid-line shift of 5 mm. Since the Sabin-Feldman
       test titre had increased, and there was no evidence to suggest a
       lymphoma or a viral or fungal infection, toxoplasmosis resistant to
       standard therapy was postulated, and treatment was started with
       clindamycin (600 mg three times daily) and pyrimethamine (25 mg four
       times daily). The clinical features subsided within 4 days. A further
       check CT scan 14 days later showed almost complete resolution.
 DE    Antibiotics, Combined/THERAPEUTIC USE  AIDS-Related Opportunistic
       Infections/*DRUG THERAPY  Case Report  Clindamycin/THERAPEUTIC USE
       Dexamethasone/ADMINISTRATION & DOSAGE  Drug Resistance, Microbial
       English Abstract  Folic Acid/ADMINISTRATION & DOSAGE  Human  Male
       Middle Age  Pyrimethamine/*ADMINISTRATION & DOSAGE
       Sulfadiazine/*ADMINISTRATION & DOSAGE  Tomography, X-Ray Computed
       Toxoplasmosis, Cerebral/*DRUG THERAPY/RADIOGRAPHY  JOURNAL ARTICLE

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