Cerebral toxoplasmosis in a patient with common variable immunodeficiency

Abstract

Cerebral toxoplasmosis is commonly seen as an opportunistic disease in patients with compromised cellular immunity.1 Thus far, purely humoral immune defects, as seen in common variable immunodeficiency (CVID), have not been described to facilitate cerebral toxoplasmosis. Here, we present a patient with intracerebral mass lesions caused by toxoplasmosis, which were apparently facilitated by a humoral immune defect with combined immunoglobulin (Ig) A, IgG, and IgM deficiency. A 52-year-old woman subacutely developed gait difficulties, impaired upper limb coordination, and swallowing and articulation difficulties. The patient had a history of CVID, which had been substituted with 10 g Igs every month. Four weeks before neurologic symptoms, an attack of autoimmune hemolytic anemia was managed with prednisolone in a dosage that was tapered from 100 to 30 mg/d. Clinically, the patient had moderate spastic tetraparesis and severe dysarthria and dysphagia. C-reactive protein was slightly elevated to 1.1 mmol/L. Temperature, white blood cells, and differential hemogram revealed no abnormalities. Lymphocytic subpopulations were normal, except for an elevation of CD19+ B cells to 0.63/nL (normal range, 0.1 to 0.4). Igs were decreased with IgA <5 …