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Toxoplasma Meningoencephalitis With Hypoglycorrhachia

Cindy Grines, MD; Joseph F. Plouffe, MD; Ian M. Baird, MB, ChB; Nariosang Kandawalla, MD
Arch Intern Med. 1981;141(7):935. doi:10.1001/archinte.1981.00340070115023.
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The occurrence of low CSF glucose levels in Toxoplasma meningoencephalitis not widely recognized and, unfortunately, led us to incorrect presumptive diagnoses.

REPORT OF CASES  Two patients with Hodgkin's disease who were treated with radiation and combination chemotherapy had fever and minimal neurologic symptoms. Physical examination findings were unremarkable except for fever and lethargy. Laboratory abnormalities included 20 to 40 lymphocytes per cubic millimeter, increased protein concentration (108 to 364 mg/dL), and depressed glucose concentration (23 and 32 mg/dL). Special stains and cultures were not helpful. Both patients were treated empirically for fungal or tuberculous meningoencephalitis. Their conditions steadily degeriorated, and they died. Histopathologic sections of brain tissue demonstrated necrotizing cerebritis with Toxoplasma cysts and trophozoites (Figure). The titer of serum indirect fluorescent antibody (IgG) to Toxoplasma reported after death in one patient was 1:256.

COMMENT  Toxoplasma gondii can be an important pathogen in the compromised host and is capable of

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