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Cerebral toxoplasmosis, miliary tuberculosis and HIV co-infection with CD4 count of 446 cells/mm3: an unsual case report

Cerebral toxoplasmosis and tuberculosis miliaria are major and serious opportunistic infections, usually occurring in HIV-positive individuals with CD4 counts< 200 cells/mm3. We report here a case in a 56-year-old patient with toxoplasmosistuberculosis- HIV co-infection with CD4 count of 446 cells/mm3. Under multidrug therapy (cotrimoxazole and first-line antituberculosis drugs), the favorable evolution (clinical improvement) was observed on the fourteenth day of cotrimoxazole treatment. High antiretroviral therapy (HAART) was reintroduced on the fifteenth day of anti-tuberculosis treatment, after two sessions of psychotherapy. Through this clinical case, the practitioner should be warned about the possibility of concomitant opportunistic infections in an HIV immunocompromised patient, especially without chemoprophylaxis, whatever his CD4 count. 