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Case Reports
. 2018 May 15;57(10):1463-1468.
doi: 10.2169/internalmedicine.0139-17. Epub 2018 Jan 11.

Cerebral Toxoplasmosis Diagnosed by Nested-polymerase Chain Reaction in a Patient with Rheumatoid Arthritis

Jun Matsuura  1 , Akihiro Fujii  2 , Ikuko Mizuta  1 , Kazumi Norose  3 , Toshiki Mizuno  1
Affiliations
Case Reports

Cerebral Toxoplasmosis Diagnosed by Nested-polymerase Chain Reaction in a Patient with Rheumatoid Arthritis

Jun Matsuura et al. Intern Med. .

Abstract

A 65-year-old woman with rheumatoid arthritis (RA) visited our hospital because of right facial sensory hypoesthesia. Cerebral toxoplasmosis was suspected on brain magnetic resonance imaging. We discontinued methotrexate for RA and started a sulfamethoxazole/trimethoprim (ST) mixture. Although ST treatment was interrupted because of adverse reactions, her prognosis was favorable. The Toxoplasma 18S rDNA gene was detected by nested-polymerase chain reaction (PCR) from blood and cerebrospinal fluid. Detecting the Toxoplasma 18S rDNA gene by nested-PCR is useful for the diagnosis and safer than a brain biopsy. In addition, the discontinuation of immunosuppressants may be recommended in patients compromised by those immunosuppressants.

Keywords: cerebral toxoplasmosis; methotrexate; nested-PCR; rheumatoid arthritis.

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Figures

Figure 1.
Figure 1.
MRI. (a) FLAIR imaging at her first visit showing an abnormal signal at the medulla oblongata to the inferior cerebellar peduncle. (b, c) Gadolinium-enhanced T1-weighted imaging 11 (b) and 35 (c) days after symptom onset. FLAIR: fluid attenuated inversion recovery
Figure 2.
Figure 2.
Clinical course. IgM (closed triangle), anti-T. gondii immunoglobulin M antibody in the serum; IgG (closed circle), anti-T. gondii immunoglobulin G antibody in the serum. ST: sulfamethoxazole/trimethoprim, RA: clinical activity of rheumatoid arthritis
Figure 3.
Figure 3.
Nested-PCR products of Toxoplasma 18S rDNA amplified from blood (lane 1) and aliquots of CSF (lanes 2-10) were electrophoresed along with a negative control (N), positive control (P), and size marker (M). The amplified band was detected in the blood and 1 aliquot (lane 3) of 9 CSF samples. Arrows: 291 bp. PCR: polymerase chain reaction, CSF: cerebrospinal fluid
See this image and copyright information in PMC

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