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Okubo et al. Journal of Medical Case Reports 2010, 4:265 http://www.jmedicalcasereports.com/content/4/1/265

JOURNAL OF MEDICAL

CASE REPORTS
Open Access

CASE REPORT

Diagnosis of systemic toxoplasmosis with HIV infection using DNA extracted from paraffinembedded tissue for polymerase chain reaction: a case report
Yoichiro Okubo1, Minoru Shinozaki1, Sadako Yoshizawa2, Haruo Nakayama1,Megumi Wakayama1, Tsutomu Hatori1, Aki Mituda1, Takayuki Hirano1, Kayoko Shimodaira1, Zhi Yuzhu1, Kazutoshi Shibuya1*

Abstract
Introduction: Toxoplasmosis can be a life-threatening disease when it occurs in patients with HIV infection. In particular, meningioencephalitis has been regarded as the most common toxoplasmic complication in such patients. However, toxoplasmic meningitis in a patientwith HIV infection is extremely rare and purulent or tuberculous meningitis should be considered initially as a disease for differential diagnosis in Japan. Case presentation: Toxoplasmic meningitis in a patient with HIV infection is reported. A 36-year-old Japanese man presented with fever, pulsating headache, lumbago, nausea, and vomiting. No examinations suggested toxoplasmosis includingcerebrospinal fluid examinations, images, and serological tests. The result of a polymerase chain reaction assay using paraffin-embedded section was regarded as the conclusive evidence for the diagnosis. Conclusions: We wish to emphasize the usefulness of polymerase chain reaction assays with nucleic acid extracted from paraffin-embedded tissue sections processed for routine histopathologicalexamination, if the section shows the infectious agents or findings suggesting some infectious diseases.

Introduction Toxoplasma gondii is known as one of the most common infectious protozoan parasites that has a worldwide distribution [1-3]. Cats are recognized as the only definitive hosts of T. gondii, but humans can be infected by the ingestion of oocysts or tissue cysts [4]. T. gondii infection isgenerally asymptomatic or associated with lymphadenopathy and manifests as a flu-like illness in immunocompetent individuals. However, the infection causes severe and fatal complications, especially in the central nervous system, in immunocompromised individuals [2,5]. This paper describes a case of toxoplasmosis in patient with HIV infection that was diagnosed by polymerase chain reaction (PCR)with the use of nucleic acid extracted from formalin-fixed and paraffin-

embedded tissue (bone marrow aspiration clot) sections prepared for routine histopathological examination.

* Correspondence: kaz@med.toho-u.ac.jp 1 Department of Surgical Pathology, Toho University School of Medicine, 6-11-1 Omori-Nishi, Ota-Ku, Tokyo, 143-8541, Japan Full list of author information is available at theend of the article

Case presentation A 36-year-old Japanese man with a 14-month history of HIV infection presented with fever, pulsating headache, lumbago, nausea, and vomiting four week prior to his admission. Although highly active anti-retroviral therapy (HAART) had been started (lamivudine, azidothymidine, and lopinavir plus ritonavir) after completion of treatment for pneumocystis pneumonia,which had been the initial clinical manifestation of our patient, his CD4-positive lymphocyte counts in peripheral blood has never recovered to more than 200 cells/mm3. Therefore, three months before admission, abacavir was given instead of azidothymidine, but was also insufficient for increasing CD4-positive lymphocytes. Furthermore, according to the guidelines, prophylaxis against Pneumocystisjirovecii had been started. In our case, atovaquone had been administered, because sulfamethoxazole-trimethoprim

© 2010 Okubo et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium,...