Pope-Pegram L, Gathe J, Bohn B, Piot D, Stool E; International Conference on AIDS.
Int Conf AIDS. 1991 Jun 16-21; 7: 188 (abstract no. M.B.2027).
Speial Diseases Unit, Park Plaza Hospital, Houston, Texas, USA
OBJECTIVE: To describe the efficiency of Doxycycline in AIDS patients with presumed central nervous system toxoplasmosis. METHODS: Prospective evaluation of two AIDS patients in which Doxycycline was utilized in therapy of presumed central nervous system toxoplasmosis (P-CNS-T). Appropriate history, physical examination and Magnetic Resonance Imaging (MRI) scans are available for review. RESULTS: (Patient 1) 33 year old male on AZT therapy for seven months with his only previous findings being oral candidiasis, when he developed acute onset of focal seizures involving the left arm without headache, fever, or other neurological findings. MRI scan revealed three intracranial lesions, the largest 3 cm. in the left posterior parietal area. Lab data was normal. Treatment with Doxycycline 100 mg IV q 8 h (4 mgm/kg/day), was begun as the sole antimicrobial, along with tapering doses of Decadron. Though asymptomatic on day eight, his MRI scan was worse with enlargement of the parietal lesion to 5 cm. and the development of two new lesions. On day eighteen, he was readmitted with altered mental status without focal findings. Repeat MRI scanning, however, revealed a dramatic decrease in size of the left parietal lesion to less than one cm., and disappearance of all other lesions. Steroid psychosis was diagnosed and his mental status returned to normal when Decadron was discontinued. He remains asymptomatic on oral Doxycycline with a completely normal MRI at fifteen weeks of follow-up. (Patient 2) 54 year old male had AIDS for three months when he developed acute iritis. A MRI scan noted three intracranial lesions, the largest being a 2x2 cm. with a central nidus surrounded by edema. A diagnosis of toxoplasma endophthalmitis and encephalitis was made. Therapy with Pyrimethamine and Sulfadiazine was initiated and clinical improvement was noted after eight weeks. Pyrimethamine was continued alone after twenty (20) weeks, due to drug hypersensitivity to Sulfa and Clindamycin. Within two months, symptomatic Toxoplasma encephalitis was again noted with a MRI scan revealing a 5-6 cm. right fronto-parietal lesion. Doxycycline, 100 mg IV q 8 h (4 mgm/kg/day) was added, and by day twelve, his MRI revealed virtual disappearance of the lesion. Doxycycline was continued alone, with an MRI scan two months later, showing no active disease. Unfortunately, the patient died three weeks later due to Staphylococcus sepsis. CONCLUSION: 1) Available therapy for P-CNS-T in patients with AIDS may be poorly tolerated due to toxicity or drug hypersensitivity. 2) Doxycycline in doses chosen lead to control of P-CNS-T with good efficacy and minimal toxicity. 3) Further trials of Doxycycline for P-CNS-T are warranted.
Publication Types:
Keywords:
- Acquired Immunodeficiency Syndrome
- Anti-Infective Agents
- Candidiasis, Oral
- Clindamycin
- Doxycycline
- Encephalitis
- Humans
- Longitudinal Studies
- Magnetic Resonance Imaging
- Male
- Pyrimethamine
- Stereotaxic Techniques
- Sulfadiazine
- Toxoplasmosis, Cerebral
- diagnosis
- surgery
- therapy
Other ID:
UI: 102182950
From Meeting Abstracts