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Войти в исследования Annals of medicine and surgery (2012) · 2026
Concurrent postpartum cerebral venous thrombosis and acute toxoplasmosis-debut of a unique clinical convergence: a case report.
Клинический случайСтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Saleem Shafaq, Haroon Muhammad, Raza Ahmad, Razzaq Azeen, Sabir Beenish, Rehman Shaheem Ur, Iqbal Muhammad Usman, Hajj Fatima
Аннотация
INTRODUCTION AND IMPORTANCE: Cerebral venous thrombosis (CVT) is a rare but serious condition, with pregnancy and puerperium representing major risk factors. Toxoplasma gondii typically causes asymptomatic infection in immunocompetent individuals. No case of concurrent postpartum CVT and acute toxoplasmosis has previously been reported.
CASE PRESENTATION: A 27-year-old woman presented 14 days postpartum with headache, fever, altered sensorium, and left-sided weakness. Neurological examination revealed a Glasgow Coma Scale score of 8/15 with focal deficits. Serology demonstrated positive Toxoplasma gondii IgM antibodies, indicating a recent infection. MRI/MRV confirmed multiple venous infarcts with hemorrhagic transformation, consistent with CVT. Protein C and S levels were reduced; however, these were interpreted cautiously, as acute thrombosis, systemic inflammation, and puerperium can transiently lower natural anticoagulant levels. Repeat testing post-recovery was planned. The patient was managed with anticoagulation, corticosteroids, and supportive care, followed by oral rivaroxaban and physiotherapy, achieving significant neurological recovery over 2 months.
CLINICAL DISCUSSION: The concurrence of postpartum CVT and positive Toxoplasma gondii serology is unprecedented. Pregnancy-related hypercoagulability, compounded by infection-induced endothelial dysfunction, likely contributed to thrombosis. Reduced Protein C and S levels, measured during acute thrombosis or puerperium, may not reflect inherited deficiency; repeat testing after anticoagulation completion is necessary before diagnosing congenital deficiency. Anticoagulation, per international guidelines, remained the cornerstone of management and proved effective despite hemorrhagic infarcts.
CONCLUSION: This first documented case of postpartum CVT with concurrent Toxoplasma gondii serology suggestive of recent infection underscores the importance of prompt recognition and timely anticoagulation.
CASE PRESENTATION: A 27-year-old woman presented 14 days postpartum with headache, fever, altered sensorium, and left-sided weakness. Neurological examination revealed a Glasgow Coma Scale score of 8/15 with focal deficits. Serology demonstrated positive Toxoplasma gondii IgM antibodies, indicating a recent infection. MRI/MRV confirmed multiple venous infarcts with hemorrhagic transformation, consistent with CVT. Protein C and S levels were reduced; however, these were interpreted cautiously, as acute thrombosis, systemic inflammation, and puerperium can transiently lower natural anticoagulant levels. Repeat testing post-recovery was planned. The patient was managed with anticoagulation, corticosteroids, and supportive care, followed by oral rivaroxaban and physiotherapy, achieving significant neurological recovery over 2 months.
CLINICAL DISCUSSION: The concurrence of postpartum CVT and positive Toxoplasma gondii serology is unprecedented. Pregnancy-related hypercoagulability, compounded by infection-induced endothelial dysfunction, likely contributed to thrombosis. Reduced Protein C and S levels, measured during acute thrombosis or puerperium, may not reflect inherited deficiency; repeat testing after anticoagulation completion is necessary before diagnosing congenital deficiency. Anticoagulation, per international guidelines, remained the cornerstone of management and proved effective despite hemorrhagic infarcts.
CONCLUSION: This first documented case of postpartum CVT with concurrent Toxoplasma gondii serology suggestive of recent infection underscores the importance of prompt recognition and timely anticoagulation.