Evidence map›Paper›PMID 41327427›Full record

ArticleTropical medicine and health2025

Toxoplasmic encephalitis unmasked during treatment for miliary tuberculosis in a patient with human immunodeficiency virus infection: a case report and literature review.

Yuta Kubono, Akira Kawashima, Takato Nakamoto, Fumiya Kawahara, Ryo Kuwata, Eri Inoue, Naokatsu Ando, Haruka Uemura, Daisuke Mizushima, Takahiro Aoki and 3 more

Abstract read
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Article in Tropical medicine and health, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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0citing papers in PubMed
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1 · What the graph read from it

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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

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3 · Its place in the literature

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4 · The record

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PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

13 authors.

Yuta KubonoAIDS Clinical Center, National Center for Global Health and Medicine, Japan Institute for Health Security, 1-21-1 Toyama, Shinjuku ku, Tokyo, 162-8655, Japan.
Akira KawashimaAIDS Clinical Center, National Center for Global Health and Medicine, Japan Institute for Health Security, 1-21-1 Toyama, Shinjuku ku, Tokyo, 162-8655, Japan. kawashima.a@jihs.go.jp.
Takato NakamotoAIDS Clinical Center, National Center for Global Health and Medicine, Japan Institute for Health Security, 1-21-1 Toyama, Shinjuku ku, Tokyo, 162-8655, Japan.
Fumiya KawaharaDepartment of Parasitology, National Institute of Infectious Diseases, Japan Institute for Health Security, 1-23-1 Toyama, Shinjuku ku, Tokyo, 162-8640, Japan.
Ryo KuwataAIDS Clinical Center, National Center for Global Health and Medicine, Japan Institute for Health Security, 1-21-1 Toyama, Shinjuku ku, Tokyo, 162-8655, Japan.
Eri InoueAIDS Clinical Center, National Center for Global Health and Medicine, Japan Institute for Health Security, 1-21-1 Toyama, Shinjuku ku, Tokyo, 162-8655, Japan.
Naokatsu AndoAIDS Clinical Center, National Center for Global Health and Medicine, Japan Institute for Health Security, 1-21-1 Toyama, Shinjuku ku, Tokyo, 162-8655, Japan.
Haruka UemuraAIDS Clinical Center, National Center for Global Health and Medicine, Japan Institute for Health Security, 1-21-1 Toyama, Shinjuku ku, Tokyo, 162-8655, Japan.
Daisuke MizushimaAIDS Clinical Center, National Center for Global Health and Medicine, Japan Institute for Health Security, 1-21-1 Toyama, Shinjuku ku, Tokyo, 162-8655, Japan.
Takahiro AokiAIDS Clinical Center, National Center for Global Health and Medicine, Japan Institute for Health Security, 1-21-1 Toyama, Shinjuku ku, Tokyo, 162-8655, Japan.
Kisaburo NagamuneDepartment of Parasitology, National Institute of Infectious Diseases, Japan Institute for Health Security, 1-23-1 Toyama, Shinjuku ku, Tokyo, 162-8640, Japan.
Katsuji TeruyaAIDS Clinical Center, National Center for Global Health and Medicine, Japan Institute for Health Security, 1-21-1 Toyama, Shinjuku ku, Tokyo, 162-8655, Japan.
Hiroyuki GatanagaAIDS Clinical Center, National Center for Global Health and Medicine, Japan Institute for Health Security, 1-21-1 Toyama, Shinjuku ku, Tokyo, 162-8655, Japan.

Funding

Japan Agency for Medical Research and Development 23fk0410038h003Japan Agency for Medical Research and Development 25jk0210050h0002National Center for Global Health and Medicine 23A2017
6 · The paper itself

Abstract

backgroundToxoplasmic encephalitis (TE) and tuberculoma are the leading causes of ring-enhancing brain lesions in patients with human immunodeficiency virus (HIV) infection. Because imaging findings of the two conditions overlap and cerebrospinal fluid (CSF) tests lack sensitivity, timely diagnosis is critical. Herein, we report the rare case of a patient with HIV infection and miliary tuberculosis who developed intracranial mass lesions after antiretroviral therapy (ART) initiation with high-dose prednisolone administration. CASE PRESENTATION: A 53-year-old Nepalese man who had been living in Japan was diagnosed with HIV infection (CD4 count, 146 cells/µL) and miliary tuberculosis. Four-drug rifabutin-based therapy was initiated. However, trimethoprim-sulfamethoxazole (TMP-SMX) prophylaxis was discontinued because of a rash and replaced with monthly pentamidine. ART (dolutegravir/lamivudine) was initiated 3 weeks later. Prednisolone (60 mg/day) was administered for refractory tuberculous ascites, and the dose was tapered over 6 weeks. Eight weeks after ART, the patient developed a headache, and laboratory tests revealed a CD4 count of 384 cells/µL. Magnetic resonance imaging (MRI) revealed right frontal ring-enhancing lesions. CSF was acellular; polymerase chain reaction yielded negative results for several pathogens including Mycobacterium tuberculosis and positive results for Toxoplasma gondii. After a 5-day graded TMP-SMX desensitization, the patient received full-dose therapy for 6 weeks, followed by secondary prophylaxis. The patient's headache resolved, and repeat MRI after 2 weeks revealed marked regression of the lesions. No radiological relapse was observed 3 months after treatment completion.

conclusionsTE can emerge during immune recovery at CD4 counts > 100 cells/µL when corticosteroid administration coincides with early ART. In patients receiving tuberculosis treatment who develop new brain lesions soon after ART, T. gondii polymerase chain reaction and prompt antiparasitic therapy should be pursued. Rifabutin permits concomitant use of dolutegravir, and TMP-SMX desensitization allows effective treatment and prophylaxis.

Indexed as

Case reportHuman immunodeficiency virusOpportunistic infectionPolymerase chain reactionToxoplasma gondiiToxoplasmic encephalitis

Identifiers

PMID41327427
PMCPMC12667162

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.