Video: Every Case Tells a Story| Webinar: ACR/CHEST ILD Guidelines in Practice

An official publication of the ACR and the ARP serving rheumatologists and rheumatology professionals

Case Study: Cerebral Toxoplasmosis in a Newly Diagnosed Lupus Patient

Komal Ejaz, MD, & Muhammad Ali Raza, MD  |  Issue: March 2021  |  

Conclusion

It can be challenging to diagnose central nervous system infections in SLE patients presenting with non-specific neurological manifestations. Opportunistic infections, such as cerebral toxoplasmosis, should be kept in mind in addition to the more obvious diagnosis of lupus cerebritis and ischemic/embolic stroke when dealing with SLE patients presenting with altered mental status. When suspected, imaging, such as CT and MRI of the brain, and serological testing should be pursued—particularly if symptoms don’t improve with immunosuppressive therapy.

Komal Ejaz, MDKomal Ejaz, MD, is a resident in internal medicine at the Wright Center for Graduate Medical Education, Scranton, Pa.

ADVERTISEMENT
SCROLL TO CONTINUE

Muhammad Ali Raza, MDMuhammad Ali Raza, MD, is a resident in internal medicine at Conemaugh Memorial Medical Center/Temple University, Johnstown, Pa.

References

  1. Jung JY, Suh CH. Infection in systemic lupus erythematosus, similarities, and differences with lupus flare. Korean J Intern Med. 2017 May;32(3):429–438.
  2. Lyngberg KK, Vennervald BJ, Bygbjerg IC, et al. Toxoplasma pericarditis mimicking systemic lupus erythematosus. Diagnostic and treatment difficulties in one patient. Ann Med. 1992 Oct;24(5):337–340. 
  3. Cervera R, Khamashta MA, Font J, et al. Morbidity and mortality in systemic lupus erythematosus during a 10-year period: A comparison of early and late manifestations in a cohort of 1,000 patients. Medicine (Baltimore). 2003 Sep;82(5):299–308. 
  4. Zhou W, Yang CD. The causes and clinical significance of fever in systemic lupus erythematosus: A retrospective study of 487 hospitalised patients. Lupus. 2009 Aug;18(9):807–812.
  5. Nived O, Sturfelt G, Wollheim F. Systemic lupus erythematosus and infection: A controlled and prospective study including an epidemiological group. Q J Med. 1985 Jun;55(218):271–287.
  6. Hidalgo-Tenorio C, Jiménez-Alonso J, de Dios Luna J, et al. Urinary tract infections and lupus erythematosus. Ann Rheum Dis. 2004 Apr;63(4):431–437. 
  7. Cuchacovich R, Gedalia A. Pathophysiology and clinical spectrum of infections in systemic lupus erythematosus. Rheum Dis Clin North Am. 2009 Feb;35(1):75–93.
  8. Feldman CH, Hiraki LT, Winkelmayer WC, et al. Serious infections among adult Medicaid beneficiaries with systemic lupus erythematosus and lupus nephritis. Arthritis Rheumatol. 2015 Jun;67(6):1577–1585.
  9. Luft BJ, Remington JS. Toxoplasmic encephalitis in AIDS. Clin Infect Dis. 1992 Aug;15(2):211–222.
  10. Cohn JA, McMeeking A, Cohen W, et al. Evaluation of the policy of empiric treatment of suspected Toxoplasma encephalitis in patients with the acquired immunodeficiency syndrome. Am J Med. 1989 May;86(5):521–527.
  11. Mok CC, Lau CS, Yuen KY. Cryptococcal meningitis presenting concurrently with systemic lupus erythematosus. Clin Exp Rheumatol. 1998 Mar-Apr;16(2):169–171.
  12. Zamir D, Amar M, Groisman G, et al. Toxoplasma infection in systemic lupus erythematosus mimicking lupus cerebritis. Mayo Clin Proc. 1999 Jun;74(6):575–578.
  13. Rothfield N. Clinical aspects and treatment of systemic lupus erythematosus. Curr Opin Rheumatol. 1989 Oct;1(3):327–331.
  14. Feinglass EJ, Arnett FC, Dorsch CA, et al. Neuropsychiatric manifestations of systemic lupus erythematosus: Diagnosis, clinical spectrum, and relationship to other features of the disease. Medicine (Baltimore). 1976 Jul;55(4):323–339.

Related Articles