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Toxoplasma Encephalitis — RACP Adult Medicine MCQ

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HardInfectious DiseasesToxoplasma EncephalitisRACP Adult Medicine

A renal-transplant recipient develops fever, seizures and multiple basal-ganglia ring-enhancing lesions six months after transplantation. Toxoplasma serology supports reactivation and no tissue diagnosis is immediately safe. What empiric treatment is appropriate?

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Correct answer: A — Start pyrimethamine plus sulfadiazine and folinic acid while pursuing diagnostic confirmation

The best answer is “Start pyrimethamine plus sulfadiazine and folinic acid while pursuing diagnostic confirmation”. Cerebral toxoplasmosis classically causes multiple ring-enhancing basal-ganglia lesions in cellular immunosuppression. Pyrimethamine, sulfadiazine and folinic acid is a standard regimen; alternatives are used for allergy or access. Differential diagnoses include lymphoma, nocardiosis and fungal or mycobacterial infection, so microbiological and sometimes tissue confirmation remains important.

Reference: ASHM: HIV management guide for clinical care in Australia: https://ashm.org.au/resources/hiv-management-guide-for-clinical-care/ CDC: Clinical care of toxoplasmosis: https://www.cdc.gov/toxoplasmosis/hcp/clinical-care/index.html