1.Toxoplasmosis presenting with multiple cranial nerve palsies and cavernous sinusitis: A case report
Jing Liu ; Beilin Zhang ; Lexiang Cui ; Teng Zhao ; Ren sheng Zhang ; Hongchao Liu ; Heqian Du ; Jiguo Gao ; Shaokuan Fang
Neurology Asia 2019;24(2):171-173
Toxoplasmosis is a worldwide zoonosis caused by an intracellular protozoan parasite, Toxoplasma
gondii. We report here a diabetic patient who was diagnosed as toxoplasmosis with multiple cranial
nerve palsies and cavernous sinusitis. A 37-year-old male presented with an 11-day history of gingival
pain, one day history of ptosis and diplopia. He has been having diabetes mellitus for 6 years, and has
a history of contact with cats. After admission, his symptoms worsened with right 3rd to 7th cranial
nerve palsies. The brain magnetic resonance imaging (MRI) showed cavernous sinusitis in the right
sellar region. Serology for toxoplasma was positive for IgM and negative IgG. The patient was treated
with oral clindamycin (900 mg/day) and dexamethasone (15 mg/day). The right visual acuity and
lid-conjunctival swelling improved after 3 days. At follow-up after a month, the movement of the
right eye significantly improved. This case demonstrate the rare occurrence of multiple cranial nerve
(3rd to 7th) palsies from toxoplasmosis cavernous sinusitis, which is a potentially treatable condition.
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