Severe congenital toxoplasmosis with isolated central hypothyroidism: A rare case report.
K Abi El Aala, A Lalaoui, G Kassal et al.
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Case in brief
A preterm newborn at 35 weeks’ gestation had severe congenital toxoplasmosis, confirmed by positive IgM/IgG serology and cerebrospinal fluid PCR. Imaging showed major triventricular hydrocephalus, multiple cystic formations, and cerebral calcifications; eye examination found bilateral cataracts, microphthalmia, and retinal detachment. Endocrine testing identified central hypothyroidism (TSH 0.012 mIU/L; T4 4.31 pmol/L), with other hypothalamic-pituitary axes normal. The infant received antiparasitic therapy and levothyroxine but died on day 54 of life from a nosocomial infection.
What made this case unusual
The reported case combined severe congenital toxoplasmosis with isolated central hypothyroidism, while assessment of the other hypothalamic-pituitary axes was normal.
Diagnostic / clinical pearl
In neonates with severe central nervous system involvement from congenital toxoplasmosis, endocrine assessment may identify central hypothyroidism even when other hypothalamic-pituitary axes are preserved.