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We describe a case of congenital toxoplasmosis with absent serum serological markers in mother and baby, presence of periventricular cysts on radiology and jelly-like coagulum within the dilated ventricles at autopsy, extremely rare features of congenital toxoplasmosis which have not been reported in the literature.
A 45-day-old female baby (first live born of non-consanguineous marriage delivered at 32 weeks) presented with generalised seizures and poor feeding. The mother had a previous abortion at 17 weeks with no cause identified. On examination, no dysmorphic features, pallor, jaundice, oedema or rash was noted. The occipito-frontal circumference was 32 cm (<−2SD) and weight 1.6 kg (below the third centile). Examination revealed wide, bulging anterior fontenella, and the eyes were normal. Blood counts, serum electrolytes, renal and liver function test were normal. The cerebrospinal fluid (CSF) examination revealed pleocytosis (520 cells), raised protein (2.5 g) and reduced glucose (10 mg/dl). IgG and IgM ELISA in the mother's and baby's serum was non-suggestive on two occasions. IgG ELISA in patient's CSF was non-suggestive, but IgM was high. The fungal and tuberculosis work-up was negative. Ultrasonography of the head showed increased echogenicity of ventricles with echogenic walls suggestive of ventriculitis and multiple hyperdense lesions in bilateral basal ganglia and cerebral hemispheres suggestive of infarct or abscess. The ventricular head size ratio varied between 58% and 71%. The cranial CT revealed gross dilatation of the ventricular system indicating communicating hydrocephalus. The ventricles showed much higher attenuation contents than normal CSF. Mild enhancement of the ventricular walls was seen, suggestive of ventriculitis. Additionally, large well-defined periventricular cysts were seen along thalami, basal ganglia and perimesencephalic cisterns (figure 1A,B). No …