Failure of conventional treatment with pyrimethamine and sulfadiazine for secondary prophylaxis of cerebral toxoplasmosis in a patient with AIDS.

摘要

Cerebral toxoplasmosis remains one of the AIDS-defming events associated with the highest mortality.1 The disease remains challenging despite the striking decrease in its incidence associated with the advent of highly active antiretroviral therapy (HAART).2 We report a case of relapse of cerebral toxoplasmosis despite conventional secondary prophylaxis, which relies on half-dose pyrimethamine and sulfadiazine until immune status has been restored for 6 months.3 A slight decrease in CD4+ T cell proportion was the only announcing event, whereas initial Toxoplasma strain typing (type II) and ongoing virological response were reassuring. This report should raise awareness of the possible failure of the conventional strategy, and of the importance of all available parameters in assessing residual risk.