Treatment of presumed cerebral toxoplasmosis with azithromycin
Godofsky, E.W.
New England Journal of Medicine 330(8): 575-576
1994
ISSN/ISBN: 0028-4793 PMID: 8302335 Document Number: 425262
A 28-year-old man with AIDS was hospitalised due to nausea, vomiting and dizziness. Magnetic resonance imaging (MRI) revealed a 1 cm by 1.5 cm ring-enhancing lesion in the left-middle cerebellar peduncle, associated with moderate oedema. IgG serological testing for toxoplasmosis had previously given positive results. Because of a documented severe allergy to sulfa drugs, the patient was treated with clindamycin, pyrimethamine and folinic acid for presumed cerebral toxoplasmosis. Corticosteroids were avoided, although infusions of mannitol were given. One week later, a severe maculopapular eruption prompted the discontinuation of therapy for toxoplasmosis and the rash subsequently improved. After a loading dose of 1500 mg, oral monotherapy with azithromycin (1000 mg daily) was begun. After 3 weeks a second MRI scan showed marked improvement and after 6 weeks a further scan showed near complete resolution of the cerebellar lesion. Maintenance therapy of 500 mg azithromycin daily was given. A final scan after 6 months showed no recurrence.