Cerebral Toxoplasmosis with Decubitus Ulcers as Human Immunodeficiency Virus Coinfection: A Neglected Case from a Seroconcordant Couple

Abstract

Cerebral toxoplasmosis is a severe opportunistic infection of the advanced stage of human immunodeficiency virus (HIV). Complications of decubitus ulcers are a threat that increases morbidity and mortality. A 56-year-old woman came with an open wound on her lower back, accompanied by weakness of the right limbs and left leg for a month. There was a history of brain swelling with craniotomy intervention a month before admission. The patient and her husband were confirmed HIV positive. On physical examination, there was a decubitus ulcer in the sacral region with right hemiparesis and left leg monoparesis. CD4+ levels were 42 cells/μL (4.9%), and anti-toxoplasma IgG was more than 300 IU/mL. There was a cerebral abscess in the left hemisphere with midline deviation to the right on a head CT scan with contrast. Head MRI with contrast showed tuberculomatosis with multiple nodular lesions in the right and left hemispheres. Surgical debridement was performed. Pharmacological therapy includes antiretroviral, antibiotics for cerebral toxoplasmosis, and prophylaxis. Improving awareness of HIV in seroconcordant couples is important for the early management and prevention of severe opportunistic infections and their complications.