Keywords
cerebral toxoplasmosis
opportunistic infections
antiretroviral therapy
clinical case
osteopathic treatment of cervicalgia
Abstract
Introduction. Cerebral toxoplasmosis is one of the most common and life-threatening opportunistic infections in patients with advanced stages of HIV. Its diagnosis can be complicated by the non-specificity of the initial neurological symptoms, which often disguises itself as other diseases, which leads to a late start of therapy and a worsening of the prognosis.
Goal is to describe a complex clinical case of late diagnosis of HIV, manifested by cerebral toxoplasmosis against the background of initial vertebrogenic complaints, and to analyze the effectiveness of therapeutic and diagnostic tactics.
Materials and methods. Based on prospective follow-up description of the case of a 45-year-old patient, who was under dynamic control for 12 and followed 8 years observation is presented. Clinical and neurological examination data, laboratory tests (PCR of blood and cerebrospinal fluid, HIV immunoblot), MRI were used.
Results. A patient with initial complaints of cervicalgia and lumbalgia developed focal neurological deficits (hemiparesis, tremor, myoclonia, diplopia) and progressive cachexia within a few months. In the hospital, the diagnosis of the HIV, cerebral toxoplasmosis was established. After specific therapy for toxoplasmosis, the patient was discharged from the hospital. Subsequently, after the introduction of HAART, all neurological symptoms gradually regressed completely. Later, during the observation for 8 years, the patient did not complain. Thus, multidisciplinary cooperation allowed not only to stop infectious and neurological manifestations, but also to achieve long-term remission in a patient with newly diagnosed stage IVB HIV.
Conclusions. The presented observation clearly demonstrates that persistent pain syndrome can act as a “mask” for the onset of AIDS-indicator diseases. Despite the high mortality rate in cerebral toxoplasmosis (30–50 % in the pre-ART era), timely combination therapy allows for stabilization and significant improvement in prognosis, with a 5-year survival rate of more than 60 %. A key success factor is a comprehensive multidisciplinary approach.
For citation
Rubinov MA, Rubinov DM, Mogilenskikh PM. Clinical mask of vertebrogenic pathology in the manifestation of aids-associated cerebral toxoplasmosis. 2025;10(4):e00192. (In Russ.). DOI: https://doi.org/10.52420/usmumb.10.4.e00192. EDN: https://elibrary.ru/IEAMGF.
References
Веселова ЕИ, Карамов ЭВ, Кудлай ДА, Самойлова АГ, Каминский ГД. Эффективность и безопасность антиретровирусной терапии у «наивных» пациентов с поздней стадии ВИЧ-инфекции. Терапия. 2022;(3):27–34. [Veselova EI, Karamov EV, Kudlay DA, Samoilova AG, Kaminsky GD. Efficacy and safety of antiretroviral therapy in “naive” patients with late-stage HIV infection. Therapy. 2022;(3):27–34. (In Russ.)]. DOI: https://doi.org/10.18565/therapy.2022.3.27-34.
Elsheikha HM, Marra CM, Zhu X. Epidemiology, pathophysiology, diagnosis, and management of cerebral toxoplasmosis. Clinical Microbiology Reviews. 2020;34(1):00115-19. DOI: https://doi.org/10.1128/cmr.00115-19.
Trickey A, McGinnis K, Gill MJ, Abgrall S, Berenguer J, Wyen C, et al. Longitudinal trends in causes of death among adults with HIV on antiretroviral therapy in Europe and North America from 1996 to 2020: A collaboration of cohort studies. The Lancet HIV. 2024;11(3):e176–e185. DOI: https://doi.org/10.1016/s2352-3018(23)00272-2.
Mazzitelli M, Sasset L, Gardin S, Leoni D, Trunfio M, Scaglione V, et al. Real-life experience on dolutegravir and lamivudine as initial or switch therapy in a silver population living with HIV. Viruses. 2023;15(8):1740. https://doi.org/10.3390/v15081740.
Schuldt AL, Bern H, Hart M, Gompels M, Winston A, Clarke A, et al. Peripheral neuropathy in virologically suppressed people living with HIV: Evidence from the PIVOT trial. Viruses. 2024;16(1):2. DOI: https://doi.org/10.3390/v16010002.
Salis F, Belfiori M, Bellisai A, Bernardini E, Murtas M, Piras R, et al. Cognitive impairment in people living with HIV and the impact of mood: Results from a cross-sectional study. Journal of Clinical Medicine. 2024;13(6):1631. DOI: https://doi.org/10.3390/jcm13061631.
Кияшко СС, Маслова ЛН, Иванова НЕ. Диагностические трудности при очаговом поражении головного мозга у больных при ВИЧ-ассоциированном токсоплазмозе. Российский журнал персонализированной медицины. 2022;2(5):25–37. [Kiyashko SS, Maslova LN, Ivanova NE. Diagnostic difficulties in focal brain damage in patients with HIV-associated toxoplasmosis. Russian Journal for Personalized Medicine. 2022;2(5):25–37. (In Russ.)]. DOI: https://doi.org/10.18705/2782-3806-2022-2-3-25-37.
Демчило АП, Красавцев ЕЛ, Козорез ЕН. Особенности данных МРТ и клиническая картина при токсоплазмозе головного мозга у ВИЧ-инфицированных пациентов. В: Актуальные вопросы инфекционной патологии юга России. Материалы II Межрегионального научно-практического форума. АСВ-полиграфия; 2017. С. 51–52. [Demchilo AP, Krasavtsev EL, Kozorez EN. Features of MRI data and the clinical picture of brain toxoplasmosis in HIV-infected patients. In: Topical issues of infectious pathology in the south of Russia. ASV-poligraphia; 2017. P. 51–52. (In Russ.)]. EDN: https://elibrary.ru/RSJJLV.
Фомина АА, Волкова ЕН, Альпидовская ОВ, Воробьев НА. Токсоплазмоз головного мозга и легких при ВИЧ-инфекции. В: Перспективы современных интеграционных процессов. Пути реализации инновационных решений. Сборник статей международной научной конференции. Санкт-Петербург: МИПИ им. Ломоносова; 2025. С. 10–12. [Fomina AA, Volkova EN, Alpidovskaya OV, Vorobyev NA. Toxoplasmosis of the brain and lungs in HIV infection. In: Prospects of modern integration processes. Ways to implement innovative solutions. Saint Petersburg: International Advanced Research Institute named after Lomonosov; 2025. P. 10–12. (In Russ.)]. EDN: https://elibrary.ru/KKYDYR.
Вольнов ТР, Синькеев МС Токсоплазмоз как неврологическое осложнение ВИЧ-инфекции. В: Week of Russian science (WeRuS-2023). Саратов: СГМУ; 2023. С. 298–299. [Volnov TR, Sinkeev MS. Toxoplasmosis as a neurological complication of HIV infection. In: Week of Russian science (WeRuS-2023). Saratov: Saratov State Medical University; 2023. P. 298–299. (In Russ.)]. EDN: https://elibrary.ru/YMYAMI.
Колесникова ИО, Пилипенко ЕБ. Неврологические проявления ВИЧ-инфекции. В: Дни науки Крымского федерального университета им. В. И. Вернадского. Симферополь: КФУ 2016. С. 27–30. [Kolesnikova IO, Pilipenko EB. Neurological manifestations of HIV infection. In: Days of Science of the V. I. Vernadsky Crimean Federal University. Simferopol: Vernadsky CFU; 2016. P. 27–30. (In Russ.)]. EDN: https://elibrary.ru/ZAHLFV.
Рыженко АА, Фарзалиева НА. Неврологические проявления ВИЧ-инфекции. Бюллетень медицинских интернет-конференций. 2018;8(4):133. [Ryzhenko AA, Farzalieva NA Neurological manifestations of HIV infection. Bulletin of Medical Internet Conferences. 2018;8(4):133. (In Russ.)]. EDN: https://elibrary.ru/XOOAXB.
Idalene M, Talibi Alaoui Z, El Fargani R, Ait Driss W, Noura T. Cerebral toxoplasmosis with negative toxoplasmosis serology in an HIV-infected patient: Case report. International Journal of Innovative Research in Medical Science. 2024;9(12):748–750. DOI: https://doi.org/10.23958/ijirms/vol09-i12/1998
Мохов ДЕ (ред.). Остеопатия: Национальное руководство. Москва: ГЭОТАР-Медиа; 2025. 624 с. [Mokhov DE (ed.). Osteopathy: A national guide. Moscow: GEOTAR-Media; 2025. 624 p. (In Russ.)]. EDN: https://elibrary.ru/QTVKMQ.
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