Disseminated toxoplasmosis presenting as symptomatic orchitis and nephrotic syndrome

Toxoplasma gondii is a common pathogen in patients with acquired immune deficiency syndrome (AIDS). The most common modes of presentation are related to the central nervous system (CNS), usually with headache, fever, and focal neurological signs. Extra-neural manifestations are unusual in patients with AIDS. The authors present a patient with AIDS who had disseminated toxoplasmosis whose initial clinical presentation was symptomatic orchitis and the nephrotic syndrome (NS). Testicular involvement with toxoplasmosis has been described only rarely, predominantly as an incidental finding at autopsy. Toxoplasmosis is a rare cause of nephrotic syndrome, with the majority of cases associated with congenital infection. In this case, the nephrotic syndrome remitted only after orchiectomy and chemotherapy for toxoplasmosis, but recurred when the patient had a relapse of his CNS disease. Toxoplasmosis in AIDS may present with extra-neural manifestations and may be an etiologic agent for NS in some patients with AIDS.