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Distinguishing Central Nervous System Lymphoma from Toxoplasma Encephalitis
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•Type with double-spacing
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Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
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TO THE EDITOR:
In their review of primary central nervous system lymphoma, Fine and Mayer [1] recommend an empiric treatment trial for toxoplasmosis in all patients with the acquired immunodeficiency syndrome (AIDS) and a computed tomographic (CT) scan of the cranium suggestive of toxoplasmosis or lymphoma. An alternative approach would be to reserve a toxoplasmosis treatment trial for patients with the highest likelihood of toxoplasmosis, such as those with detectable serum anti-Toxoplasma IgG, those with multiple mass lesions on cranial magnetic resonance imaging (MRI), or those receiving Pneumocystis prophylaxis with agents other than trimethoprim-sulfamethoxazole.
The likelihood of Toxoplasma encephalitis is low in human immunodeficiency virus (HIV)-infected patients with nondetectable serum anti-Toxoplasma IgG [2]. In addition, a single lesion viewed by cranial MRI is more likely to be caused by primary central nervous system lymphoma than to toxoplasmosis [3]. The presence of Epstein-Barr virus DNA in cerebrospinal fluid has been shown to be a sensitive and specific way to distinguish primary central nervous system lymphoma from Toxoplasma encephalitis [4]. Preliminary data also suggest that thallium single-photon emission computed tomography (SPECT) may also be able to make this distinction accurately [5].
Rather than undergoing a low-yield treatment trial, patients who are unlikely to have Toxoplasma encephalitis and in whom primary central nervous system lymphoma is suspected could be further evaluated with such tests as cerebrospinal fluid studies for Epstein-Barr virus DNA, thallium SPECT, or brain biopsy.
Christina Marra, MD
University of Washington School of Medicine; Seattle, WA 98104-2499
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright ©2004 by the American College of Physicians
