Congenital Toxoplasmosis with Cranial Diabetes Insipidus and Hydrochlorothiazide
https://doi.org/10.15605/jafes.041.S1
- Author:
May Hou Yap
1
;
Nurul Farah Wahidah Abd Razak
1
;
Sze Teik Teoh
1
Author Information
1. Hospital Sultanah Bahiyah
- Publication Type:Journal Article
- MeSH:
oxoplasmosis, Congenital;
Hydrochlorothiazide;
Diabetes Insipidus
- From:
Journal of the ASEAN Federation of Endocrine Societies
2026;41(S1):142-
- CountryPhilippines
- Language:English
-
Abstract:
Introduction:Congenital toxoplasmosis (CTox) is common in Malaysia
and classically presents with brain and eye involvement,
causing hydrocephalus, intracranial calcifications, cataract,
chorioretinitis, blindness, epilepsy, and psychomotor or
mental impairment. Cranial diabetes insipidus (CDI) and
panhypopituitarism rarely complicate its clinical course.
Case:From 2024 to 2026, we had encountered three cases of
CTox infants, of whom 2 (C1, C2) had a stormy neonatal
period and passed away by 3 months old due to refractory
seizures, while the 3rd (C3) survived. C1 (2.2 kg) was
diagnosed antenatally from fetal ultrasound brain with
severe ventriculomegaly, whereas C2 (2.47 kg) had multiple
syndromic features, cleft lip, palate and anopthalmos. C3
(2.6 kg) was only diagnosed later by 1-month-old when she
had afebrile seizures. C1 and C2 had severe hypernatremia
(Na >150 mmol/L) within 1st week of life, but C3 had hypernatremia after surgical drainage of her hydrocephalus and
administration of steroids. All were diagnosed with CDI
and fulfilled the triad of polyuria, hypernatremia and
inappropriate paired osmolality. During acute period,
they were managed with IV vasopressin infusion with
intensive monitoring. At low dose (0.1–0.3 mcg/kg/hour),
all achieved eunatremia and euvolemia within 12 hours
with no inadvertent hyponatremia. They also had central
hypothyroidism and received L-thyroxine, with prior
oral hydrocortisone, except C1. Their CDI persisted with
highest Na 165 mmol/L in C1. They were started on tab
hydrochlorothiazide (HCTZ) alongside low renal solute load formula (LRSL) and EBM. HCTZ dose was titrated
gradually from 0.5 to 1.0 mg/kg/dose and further to 1.5
mg/kg/dose. In between, subcutaneous desmopressin
(DDAVP) 0.02–0.04 mcg were given during breakthrough
DI. All cases responded to HCTZ at 1.5 mg/kg/dose, with
varying intervals (daily to TDS). C3 went home after
6 weeks with HCTZ, L-thyroxine and hydrocortisone,
together with oral anti-toxoplasmosis and anticonvulsants.
Conclusion:CTox with CDI presents a challenge during infancy, and a
combination of LRSL with thiazide diuretics is an acceptable alternative, prior to definitive DDAVP therapy later.
- Full text:2026081013443512820EP_P014.pdf
