Significant clinical outcome using pyrimethamine and clindamycin in cerebral toxoplasmosis with severe edema: a case report

Abstract

Introduction and Importance: Cerebral toxoplasmosis is a complication in HIV/AIDS patients that has recently increased in new cases due to increased HIV/AIDS incidents. Case Presentation: An Indonesian male, 26-year old, complained of severe headache, left hemiparesis, and tremors. A brain computed tomography scan with contrast showed a large mass, extensive edema, and a significant midline shift resembling a brain tumor. The HIV test was positive, and CD4 decreased. The patient was treated with dexamethasone, mannitol, and pyrimethamine-clindamycin as therapy. After 2 weeks of treatment, the headache, hemiparesis, and tremor were clinically improved. Two months later, a brain computed tomography scan and MRI showed a good prognosis. Clinical Discussion: The diagnosis of cerebral toxoplasmosis is based on a radiological examination and an HIV/AIDS test. Management of cerebral toxoplasmosis using pyrimethamine-clindamycin, while steroids are not recommended unless disproportionate cytotoxic edema is displayed and life-threatening. Conclusion: A combination of pyrimethamine-clindamycin, and steroids can improve the prognosis of cerebral toxoplasmosis with severe edema.