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Gazzetta Medica Italiana Archivio per le Scienze Mediche 2001 April;160(2):71-8


language: English

Toxoplasmosis, hepatitis, diabetes mellitus, toxoplasmosis septic shock, AIDS and thalidomide

Barbosa Vosgerau J. C.

Dermatologist, Centro Municipal de Especialidades, Secretariat of Health from Ponta Grossa


Progressive immunosupression in AIDS patients is often related to the onset of opportunistic infections. Their earlier diagnosis and proper treatment are important in order to avoid uncontrollable complications, unnecessary pain, anxiety, high treatment costs and death. Toxoplasmosis symptoms are protean and non-specific. It is an immunosupressive and life-threatening condition in HIV infection, particularly when it affects the central nervous system or induces hepatitis or septic shock. Thalidomide has a liver protective effect and has an important role in the treatment of hepatitis, toxoplasmosis septic shock in AIDS or diabetes mellitus (DM) patients. The follow-up is reported of a patient that had toxoplasmosis reactional state with lymphadenopathy, severe seborrheic dermatitis (SD), multiplex mononeuropathy, atypical herpes simplex, cerebral toxoplasmosis, Py overdose with severe side effects, DM type 2, hepatitis, persistent anemia, leukopenia, monocytosis, hypocholesterolemia, circulating immunocomplexes, β 2-microglobulin. Reduction of thalidomide dose after control of cerebral toxoplasmosis and Py intoxication was followed by clinical/laboratory deterioration with severe toxoplasmosis, atypical herpes simplex, DM, hepatitis, tuberculosis, arterial hypertension, toxoplasmosis septic shock onset. Hepatitis, DM, arterial hypertension, septic shock remitted with thalidomide 11.0 g/day. It was concluded: 1) SD, hepatitis and DM in this patient certainly were not different disorders but different expressions of the same disorder — IFN-γ intoxication triggered by Toxoplasma and reinforced by HIV. 2) Multiplex mononeuropathy and the onset of atypical herpes simplex associated to severe anemia and leukopenia are late signs of severe toxoplasmosis activity. 3) DM, arterial hypertension, septic shock, hepatitis, anemia, SD are more “visible” clinical/laboratory expressions of energy wasting by immune system hyperactivity triggered mainly Toxoplasma, in patients with chronic toxoplasmosis.

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