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LETTER TO THE EDITOR
Year : 2016  |  Volume : 11  |  Issue : 1  |  Page : 91-92
 

Ventriculitis and hydrocephalus with hypoglycorrhachia in congenital toxoplasma infection


Department of Neurosurgery, PGIMER, Chandigarh, India

Date of Web Publication27-Apr-2016

Correspondence Address:
Ankur Kapoor
Department of Neurosurgery, Flat No. E-33 GHS 94, Sector 20, Panchkula - 138 009, Haryana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1817-1745.181270

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How to cite this article:
Kapoor A, Sodhi HB, Dhandapani S. Ventriculitis and hydrocephalus with hypoglycorrhachia in congenital toxoplasma infection. J Pediatr Neurosci 2016;11:91-2

How to cite this URL:
Kapoor A, Sodhi HB, Dhandapani S. Ventriculitis and hydrocephalus with hypoglycorrhachia in congenital toxoplasma infection. J Pediatr Neurosci [serial online] 2016 [cited 2019 Feb 16];11:91-2. Available from: http://www.pediatricneurosciences.com/text.asp?2016/11/1/91/181270


Sir,

Congenital central nervous system toxoplasmosis can present in varied different forms. One of its rarest presentations is isolated hydrocephalus and ventriculitis with no parenchymal lesion.

A 4-month-old child was brought to the hospital with a complaint of enlarging head size, fever, and poor feeding for 3 weeks. Examination revealed enlarged head circumference and bulging anterior fontanelle. Ultrasonography showed increased echogenicity of ventricles while gadolinium-magnetic resonance (MR) revealed hydrocephalus with no focal parenchymal lesions. The debris within the ventricle was evident on MR imaging as focal hypointense lesion within the ventricle on T2-weighted image [Figure 1]. Cerebrospinal fluid (CSF) analysis showed sugar 12 mg/dl, counts 450/mm 3, and proteins 60 mg/dl. CSF was positive for polymerase chain reaction for toxoplasma while immunoglobulin G (IgG) and IgM were both negative. With a working diagnosis of congenital toxoplasmosis, the child was started on sulfadiazine and pyrimethamine therapy. The child improved clinically, started tolerating feeds and cells in CSF decreased, but sugars persistently remained below 20 mg/dl. Since the CSF picture was normal other than sugar value, we proceeded ahead with endoscopic third ventriculostomy for persistent hydrocephalus, 3 weeks later.
Figure 1: (a) T2-weighted image showing hydrocephalus with hypointensity of mural nodule in right lateral ventricle. (b) T1-weighted contrast image showing contrast enhancement of mural nodule

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Congenital toxoplasmosis results from the transplacental passage of the toxoplasma gondi parasite from the mother to the fetus. Though the majority of babies are asymptomatic, some may present with anemia, jaundice, hepatosplenomegaly, seizures, hydrocephalus, chorioretinitis, and sensori-neural deafness. Radiology shows ring enhancing lesions at corticomedullary junction, white matter of basal ganglia (75–88%), thalamus or as diffuse cerebritis.[1],[2] Ventriculitis and consecutive obstructive hydrocephalus may occur due to compression of CSF outflow pathway by ring enhancing lesions or ventriculitis.[1],[3] Postcontrast periventricular enhancement on MR imaging is consistent with ventriculitis.[2],[4] Though antitoxoplasma therapy alone may suffice and spontaneous resolution of hydrocephalus may be seen, the enlarging head circumference in our patient made CSF diversion compulsory.[4] We emphasize on early suspicion of toxoplasmosis in newborns with hydrocephalus and to proceed with CSF diversion for hydrocephalus despite persistent hypoglycorrhachia.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Akgoz A, Mukundan S, Lee TC. Imaging of rickettsial, spirochetal, and parasitic infections. Neuroimaging Clin N Am 2012;22:633-57.  Back to cited text no. 1
    
2.
Mohamed S, Osman A, Al Jurayyan NA, Al Nemri A, Salih MA. Congenital toxoplasmosis presenting as central diabetes insipidus in an infant: A case report. BMC Res Notes 2014;7:184.  Back to cited text no. 2
    
3.
Cota GF, Assad EC, Christo PP, Giannetti AV, Santos Filho JA, Xavier MA. Ventriculitis: A rare case of primary cerebral toxoplasmosis in AIDS patient and literature review. Braz J Infect Dis 2008;12:101-4.  Back to cited text no. 3
    
4.
Basavaprabhu A, Soundarya M, Deepak M, Satish R. CNS toxoplasmosis presenting with obstructive hydrocephalus in patients of retroviral disease – A case series. Med J Malaysia 2012;67:214-6.  Back to cited text no. 4
    


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