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April 2003: 55-year-old male with necrotic pontine lesion
F Alameda1, M Natcher, M J Guardiola
1Department of Pathology, Hospital del Mar, Autonomous University of Barcelona, Spain.
Abstract:
The April Case of the Month (COM). A 55-year-old male with history of diabetes mellitus presented with progressive loss of sensitivity on the left side of the body and horizontal diplopia. Symptoms appeared after a right basal pneumonia one month before admission. A CT scan showed an large inoperable lesion in the pons. The patient was treated with corticoids. One week later, the patient showed general deterioration. The fifth and sixth right cranial nerves were affected. Ataxia and disorders in swallowing were also present. A second CT scan showed that the pontine mass had become larger. The patient died 7 days after his admission and the autopsy was limited to CNS. The right middle cerebellar peduncle showed a 2-cm well-defined white brownish necrotic lesion that extended to the pons and periventricular gray matter. Microscopic examination revealed toxoplasmosis, which was confirmed by immunohistochemical studies. The brain tissue was negative for HIV by PCR. Toxoplasmosis is a well-known complication of AIDS, and has been reported in post-transplant patients as well, but only a few reports of toxoplasmosis in diabetics have been reported.
Insights
A rare case of toxoplasmosis in a diabetic patient caused a pontine lesion, leading to neurological decline and death. This highlights toxoplasmosis as a potential, though infrequent, complication in immunocompromised individuals.
Area of Science:
- Neurology
- Infectious Diseases
- Pathology
Background:
- Diabetes mellitus is a common condition.
- Toxoplasmosis is typically associated with immunocompromised states like AIDS or post-transplant patients.
- Neurological complications in diabetics often stem from vascular or metabolic issues.
Observation:
- A 55-year-old male with diabetes presented with progressive hemisensory loss and diplopia.
- Imaging revealed a large, inoperable pontine lesion.
- Clinical deterioration included cranial nerve palsies, ataxia, and dysphagia.
Findings:
- Autopsy identified a necrotic lesion in the pons and cerebellar peduncle.
- Microscopic examination and immunohistochemistry confirmed toxoplasmosis.
- Human immunodeficiency virus (HIV) testing was negative.
Implications:
- This case underscores the possibility of toxoplasmosis presenting in diabetic patients, even without overt immunosuppression.
- It expands the differential diagnosis for pontine lesions and neurological deficits in this population.
- Further investigation into the mechanisms and prevalence of toxoplasmosis in diabetics may be warranted.
