I read with renewed interest the account of pulmonary toxoplasmosis in six human immunodeficiency virus—infected patients described by Schnapp et al.1 Patient 4, with the only description of a macular rash, reminded me of a patient I saw in New York City, a construction worker in whom the initial working diagnosis was endemic typhus after he presented with fever, headache, adenopathy, diffuse macular rash, and respiratory compromise with a diffuse interstitial infiltrate. Therapy was empirically changed to trimethoprim-sulfamethoxazole when the human immunodeficiency virus antibody test results returned positive; although he improved on this regimen, subsequent bronchial lavage was negative for pneumocystosis and an open lung biopsy revealed Toxoplasma gondii pneumonia. A search revealed an early article2 that described two fatal cases of "an acute febrile, exanthematic disease" in patients in whom simulation to typhus was noted and pathologic examination revealed pulmonary toxoplasmosis. Although neither sensitive nor specific, the
Chan E. A 'Rash' of Toxoplasmosis. Arch Intern Med. 1993;153(6):780–782. doi:10.1001/archinte.1993.00410060080016
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