Diarrhea as a Presenting Symptom of Disseminated Toxoplasmosis

Disseminated toxoplasmosis is uncommon in both immunocompetent and immunocompromised hosts with gastrointestinal involvement being rarely described. We report a case of disseminated gastrointestinal toxoplasmosis in an immunocompromised man who presented with one month of diarrhea and abdominal pain. Imaging showed thickening of the ascending colon and cecum. Esophagogastroduodenoscopy and colonoscopy biopsies revealed Toxoplasma gondii, confirmed by immunostain. Symptoms completely resolved following treatment with pyrimethamine, sulfadiazine, and leucovorin. This case highlights the importance of including toxoplasmosis in the differential diagnosis of any immunocompromised individual presenting with gastrointestinal symptoms.

[1]  R. Sarpong,et al.  Bio-inspired synthesis of xishacorenes A, B, and C, and a new congener from fuscol† †Electronic supplementary information (ESI) available. See DOI: 10.1039/c9sc02572c , 2019, Chemical science.

[2]  M. Tahmasbi,et al.  Duodenal toxoplasmosis in a bone marrow transplant patient: A rare case report , 2017 .

[3]  Serkadis Debalke,et al.  Latent Toxoplasma gondii Infection and Associated Risk Factors among HIV-Infected Individuals at Arba Minch Hospital, South Ethiopia , 2014, AIDS research and treatment.

[4]  P. Wilkins,et al.  Toxoplasma gondii seroprevalence in the United States 2009-2010 and comparison with the past two decades. , 2014, The American journal of tropical medicine and hygiene.

[5]  S. Adad,et al.  Morphological changes in the digestive system of 93 human immunodeficiency virus positive patients: an autopsy study. , 2012, Revista do Instituto de Medicina Tropical de Sao Paulo.

[6]  S. Gorelick,et al.  Gastric toxoplasmosis as the presentation of acquired immunodeficiency syndrome. , 2009, Archives of pathology & laboratory medicine.

[7]  Sharenda L Williams,et al.  Disseminated Toxoplasmosis in a Patient with Undiagnosed Aids , 2009, Proceedings.

[8]  R. Walensky,et al.  Photo quiz. An HIV-infected man with an upset stomach. , 2008, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[9]  R. Hessler,et al.  Toxoplasma colitis in a patient with acquired immune deficiency syndrome. , 2006, Gastrointestinal endoscopy.

[10]  E. Weisenberg,et al.  Gastric toxoplasmosis in a patient with acquired immunodeficiency syndrome. A case report and review of the literature. , 2003, Archives of pathology & laboratory medicine.

[11]  M. Wahlgren,et al.  Parasites of the Colder Climates , 2002 .

[12]  J. Montoya Laboratory diagnosis of Toxoplasma gondii infection and toxoplasmosis. , 2002, The Journal of infectious diseases.

[13]  F. Derouin,et al.  Incidence and Risk Factors of Toxoplasmosis in a Cohort of Human Immunodeficiency Virus-Infected Patients: 1988–1995 , 1999 .

[14]  M. Yang,et al.  Disseminated toxoplasmosis as a cause of diarrhea. , 1995, Southern medical journal.

[15]  P. Ambroise‐Thomas,et al.  Extracerebral toxoplasmosis in patients infected with HIV. A French National Survey. , 1994, Medicine.

[16]  J. Michiels,et al.  Extracerebral toxoplasmosis in the acquired immunodeficiency syndrome (AIDS). , 1993, Pathology, research and practice.

[17]  D. Schürmann,et al.  Extracerebral toxoplasmosis in AIDS. Histological and immunohistological findings based on 80 autopsy cases. , 1993, Pathology, research and practice.

[18]  W. Marasco,et al.  Acquired immunodeficiency syndrome with disseminated toxoplasmosis presenting as an acute pulmonary and gastrointestinal illness. , 1991, Archives of pathology & laboratory medicine.

[19]  W. Hamlin,et al.  Disseminated toxoplasmosis in the compromised host. A report of five cases. , 1974, Archives of internal medicine.

[20]  W. Hager,et al.  and s , 2019, Shallow Water Hydraulics.

[21]  J. Berenguer,et al.  Toxoplasmosis in HIV-Infected Patients , 2015 .

[22]  L. Trudel,et al.  Gastric toxoplasmosis in acquired immunodeficiency syndrome: antemortem diagnosis with histopathologic characterization. , 1996, Gastroenterology.

[23]  B. Efron,et al.  Studies on toxoplasmosis in El Salvador. Prevalence and incidence of toxoplasmosis as measured by the Sabin-Feldman dye test. , 1970, Transactions of the Royal Society of Tropical Medicine and Hygiene.