Liver transplant, toxoplasmosis and kidney stones: connecting the dots

Due to high clinical suspicion, ring enhancing lesion on MRI and positive toxoplasma serum IgG, she was diagnosed with cerebral toxoplasmosis and initiated on sulfadiazine 1000 mg every 6 hours, Pyrimethamine and Leucovorin.1 2 Repeat MRI of the brain 3 weeks after initiation of Sulfadiazine showed improvement in the size of the lesion and vasogenic oedema suggesting response to treatment and therefore, biopsy was not pursued. Learning points Toxoplasma polymerase chain reaction testing in the Cerebrospinal Fluid has high specificity but variable sensitivity depending on the primer used. [...]it would be prudent to proceed with the treatment when the suspicion for cerebral toxoplasmosis is high. Sulfonamide antibiotics such as sulfadiazine are relatively insoluble in acid urine, especially when used in high doses to treat toxoplasmosis, which may lead to crystal-induced acute kidney injury (crystalline nephropathy) and/or nephrolithiasis from intrarenal drug precipitation.