Acquired Toxoplasmosis Accompanied by Facial Nerve Palsy in an Immunocompetent 5-Year-Old Child

Abstract

Acquired toxoplasmosis, although relatively common in children, is usually asymptomatic but can also be clinically manifested by a benign and self-limited infectious mononucleosis-like syndrome. Neurological complications are very rare in immunocompetent children. The authors report a 5-year-old boy who presented with cervical lymphadenopathy because of acquired toxoplasmosis accompanied with unilateral facial nerve paralysis. Toxoplasma gondii DNA detection in blood by polymerase chain reaction, as well as elevated specific immunoglobulin M antibodies against it, established the diagnosis. Characteristic brain lesions on magnetic resonance imaging were absent and ophthalmologic examination revealed no inflammatory lesions in the retina and choroid. Treatment with pyrimethamine, sulfadiazine, and folic acid resulted in a complete recovery after 2 months of therapy. Although rare, acute facial nerve paralysis of unknown origin can be caused by acquired toxoplasmosis even in the immunocompetent pediatric population. Elevated titers of specific antibodies and the presence of parasite's DNA are key findings for the correct diagnosis.

Recurrent seizures during acute acquired toxoplasmosis in an immunocompetent traveller returning from Africa

“…Other neurological manifestations during AAT have occasionally been described [2][3][4]. Galli-Tsinopoulou et al reported a 5-year-old boy who presented afebrile with cervical lymphadenopathy, facial nerve palsy without meningeal signs and a negative cerebral MRI [2]. In two cases of encephalitis as a part of disseminated disease, the CSF revealed slight lymphocytic pleocytosis and MRI showed no cerebral pathology [3,4].…”

“…Other neurological manifestations during AAT have occasionally been described [2][3][4]. Galli-Tsinopoulou et al reported a 5-year-old boy who presented afebrile with cervical lymphadenopathy, facial nerve palsy without meningeal signs and a negative cerebral MRI [2].…”

“…Neurological involvement in patients with AIDS or other immunodeficiency conditions is common because of reactivation of chronic Toxoplasma gondii infection, whereas it is rarely reported in immunocompetent individuals, occasionally as a manifestation of disseminated disease during AAT [2][3][4]. In the latter scenario, clinical presentation includes facial nerve palsy, intense headaches with or without meningeal signs, meningoencephalitis always associated with cervical, occipital or generalized lymphadenopathy [2][3][4].…”

Cerebral toxoplasmosis diagnosed by brain tissue PCR analysis in an immunocompetent patient

“…On the contrary, CNS toxoplasmosis is extremely rare in immunocompetent hosts and its diagnosis is commonly supported by detection of T gondii antibodies. [3][4][5][6][7] We describe an immunocompetent patient presenting life-threatening cerebral toxoplasmosis in whom both CSF analysis and serology were uninformative and the diagnosis was achieved by means of molecular amplification of T gondii DNA on brain tissue samples.…”