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Distinguishing Central Nervous System Lymphoma from Toxoplasma Encephalitis
- Howard A. Fine, MD; and
- Robert J. Mayer, MD
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IN RESPONSE:
We agree with Dr. Marra that in a patient with AIDS who has a single intracerebral lesion and a negative serum anti-toxoplasmosis IgG, the likelihood of toxoplasmosis encephalitis is small. In such a case, proceeding directly to biopsy is reasonable. Thallium-SPECT scanning and assessment of Epstein-Barr virus DNA in cerebrospinal fluid are promising new diagnostic modalities; however, their value in differentiating between cerebral toxoplasmosis and lymphoma has not been tested in large-scale, prospective trials. In general, if some chance exists that newly diagnosed intracerebral lesions are the result of toxoplasmosis and the patient is neurologically stable, we believe a 10-day course of antitoxoplasmosis therapy is preferable to an invasive procedure.
As Dr. Marra's letter points out, any proposed diagnostic algorithm merely represents a framework for physicians to make educated and appropriate decisions; however, each patient must be considered as an individual.
Howard A. Fine, MD
Robert J. Mayer, MD
Dana-Farber Cancer Institute; Havard Medical School; Boston, MA 02115
- Copyright ©2004 by the American College of Physicians
