508 - Acute Rehabilitation Optimizes Functional and Medical Outcome for Individual with CNS Toxoplasmosis and Newly Diagnosed HIV: A Case Report

Case Diagnosis: CNS Toxoplasmosis in Newly Diagnosed HIV

Case Description: 34-year-old male refugee with no known past medical history presented with acute left-sided hemiparesis and headache, found to have fever and pancytopenia. MRI revealed a heterogeneous mass lesion in his R thalamus, vasogenic edema, and ring-enhancing lesions in bilateral hemispheres. HIV testing was positive and CD4 count was 26 cells/mm3, confirming AIDS. Toxoplasmosis IgG antibodies were positive. He was treated with antimicrobial therapy followed by initiation of antiretroviral therapy. He was admitted to acute rehabilitation four days after his initial presentation requiring moderate to maximum assistance for all ADLs and mobility. His rehabilitation course was complicated by hyponatremia concerning for SIADH requiring fluid restriction, penile lesions secondary to HSV, and manic behavior. Within two weeks, he was minimum assistance for mobility and contact guard for transfers. He continues to improve at the time of submission.

Discussions: CNS toxoplasmosis is a serious opportunistic infection often seen in patients with advanced HIV/AIDS. The infection can result in significant neurological impairment and prognosis depends on several factors including the timing of treatment, extent of neurological damage, and response to rehabilitation intervention. Early treatment of CNS toxoplasmosis, particularly when accompanied by comprehensive rehabilitation, generally results in a favorable prognosis for patients with hemiparesis.

There is limited documentation of rehabilitation outcomes after newly diagnosed HIV with CNS toxoplasmosis and this patient highlights the rehabilitation potential with these serious diagnoses.

Conclusions: Early diagnosis with effective ART, targeted antimicrobial treatment, and a structured rehabilitation program are essential for optimizing recovery and improving quality of life for patients with CNS toxoplasmosis in newly diagnosed HIV, supporting the critical role of physiatry in addressing complex medical and functional needs in such patients. Interdisciplinary care, as in this case with Neurology, Infectious Disease, Psychiatry, and multimodal therapies, help to optimize patient outcomes.