corticosteroids in CNS toxoplasmosis

 Q: What is the caveat of using corticosteroids during the management of CNS toxoplasmosis?

Answer: It is not absolutely necessary to add corticosteroids in the management of toxoplasmosis. It should be used judiciously if there is a mass effect in the brain, edema or midline shift. 

Corticosteroids can deceive the actual underlying progress of the patients' response by rapidly improving only the symptoms. It reduces the ring enhancement and surrounding edema, but may also lead to secondary opportunistic infections, which can be detrimental in these immunocompromised patients.

#ID

References:

1. Sonneville R, Schmidt M, Messika J, Ait Hssain A, da Silva D, Klein IF, Bouadma L, Wolff M, Mourvillier B. Neurologic outcomes and adjunctive steroids in HIV patients with severe cerebral toxoplasmosis. Neurology. 2012 Oct 23;79(17):1762-6. doi: 10.1212/WNL.0b013e3182704040. Epub 2012 Oct 10. PMID: 23054235. 

2. Vidal JE. HIV-Related Cerebral Toxoplasmosis Revisited: Current Concepts and Controversies of an Old Disease. J Int Assoc Provid AIDS Care. 2019;18:2325958219867315. doi:10.1177/2325958219867315