A rare case of pulmonary toxoplasmosis in a patient with undifferentiated inflammatory arthritis on chronic methotrexate and corticosteroid therapy

Abdulkareem, Abdullateef; D’Souza, Ryan S; Patel, Nitin; Donato, Anthony A.

doi:10.1136/bcr-2017-221252

Cited by 5 publications

(9 citation statements)

References 19 publications

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“…Pulmonary toxoplasmosis can be difficult to diagnose due to a nonspecific and variable presentation and low awareness among healthcare providers due to its rarity [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

Pulmonary and Renal Toxoplasmosis in an Immunocompetent Adult Patient

2023

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Toxoplasmosis is caused by the protozoan parasite Toxoplasma gondii (T. gondii), which is one of the most widespread zoonotic pathogens known today. It is a global health hazard as they infect 30-50% of the world's human population. Acute toxoplasmosis is usually asymptomatic and self-limited in immunocompetent people, recovering without treatment and do not require specific therapy. Therefore, rare complications are associated with infection in the individuals with normal immune systems. However, we present a rare case of an immunocompetent man with acute T. gondii infection confirmed by serology, subsequently presented with two life-threatening organ dysfunctions: severe renal and pulmonary involvement, requiring hospitalization and anti-parasitic treatment.

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“…Pulmonary toxoplasmosis can be difficult to diagnose due to a nonspecific and variable presentation and low awareness among healthcare providers due to its rarity [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

Pulmonary and Renal Toxoplasmosis in an Immunocompetent Adult Patient

2023

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“…This disease might be misdiagnosed, or proper treatment could be delayed because of its nonspecific clinical features and imaging findings and insufficient knowledge among clinicians. Thus, it has a high mortality rate [4,10,11] …”

Section: Discussionmentioning

confidence: 99%

“…Nevertheless, only 8 reports were considered after the exclusion of studies with transplant recipients, patients with HIV, disseminated cases with main symptoms other than respiratory, nonhuman cases, articles published in languages other than English, and unknown cases (Table 1). [8,9,11,[14][15][16][17][18] As shown in Table 1, in most cases, the patient's condition improved with T. gondii-specific approaches such as T. gondii serologic testing and pyrimethamine-sulfadiazine treatment despite the presence of various and nonspecific underlying diseases and symptoms. Thus, suspected T. gondii and availability of pyrimethamine-sulfadiazine are important for the timely initiation of appropriate treatment.…”

Section: Discussionmentioning

confidence: 99%

Acute exacerbation of pulmonary toxoplasmosis during corticosteroid therapy for immune thrombocytopenia

et al. 2021

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Rationale: Pulmonary toxoplasmosis (PT) is an infectious disease that can be fatal if reactivation occurs in the recipients of hematopoietic stem cell transplantation (HSCT) who were previously infected with Toxoplasma gondii . However, whether the toxoplasmosis reactivation is an actual risk factor for patients receiving immunosuppressive therapies without HSCT remains unclear. Therefore, reactivated PT is not typically considered as a differential diagnosis for pneumonia other than in patients with HSCT or human immunodeficiency virus (HIV). Patient concerns: A 77-year-old man presented with fever and nonproductive cough for several days. He was hospitalized due to atypical pneumonia that worsened immediately despite antibiotic therapy. Before 4 months, he was diagnosed with immune thrombocytopenia (ITP) and received corticosteroid therapy. Trimethoprim–sulfamethoxazole (ST) was administered to prevent pneumocystis pneumonia resulting from corticosteroid therapy. Diagnosis: The serological and culture test results were negative for all pathogens except T. gondii immunoglobulin G antibody. Polymerase chain reaction, which can detect T. gondii from frozen bronchoalveolar lavage fluid, showed positive results. Therefore, he was diagnosed with PT. Intervention: ST, clindamycin, and azithromycin were administered. Pyrimethamine and sulfadiazine could not be administered because his general condition significantly worsened at the time of polymerase chain reaction (PCR) examination. Outcomes: The patient died of acute respiratory distress syndrome despite anti- T. gondii treatment. An autopsy revealed a severe organizing pneumonia and a small area of bronchopneumonia. Lessons: PT should be considered as a differential diagnosis in patients with pneumonia, particularly in seropositive patients who receive immunosuppressive therapies even for other than HSCT or HIV.

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“…Mortality rate among patients with toxoplasma pneumonia was 55% (Pomeroy and Filice 1992). In a case report about pulmonary toxoplasmosis in a patient with methotrexate and corticosteroid therapy a chest computed tomography showed extensive bilateral ground-glass opacities and subcentimetre bilateral hilar lymphadenopathy (Abdulkareem et al 2017).…”

mentioning

confidence: 99%

“…In University Hospital of South Manchester 100% of the patients with lung cancer were infected with T. gondii and only 10% in the controls (Bajnok et al 2019). Cases of lung lesion caused by T. gondii were described in patients with chronic inflammatory arthritis and methotrexate and corticosteroid therapy (Abdulkareem et al 2017), with leukemia (Scerra et al 2013), lung cancer (Lu et al 2015), and also in positive anti-toxoplasma serology bone marrow recipients, who got immunosuppressive therapy for "graft-versus-host" disease after allogenic transplantation, especially in highly endemic for toxoplasma areas (de Medeiros et al 2001).…”

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confidence: 99%

Invasion with Toxoplasma gondii can promote pneumocystis pneumonia in individuals with HIV/AIDS

Hryzhak¹

2021

FOLIA PARASIT

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Pulmonary pathology is common in HIV-infected individuals, but the possible role of the parasitic protist Toxoplasma gondii (Nicolle et Manceaux, 1908) is not completely known. The present account reports result of a retrospective cohort study. Medical cards of 907 HIV-positive people, which included 120 deceased patients, were analysed. During a three-year follow-up, the pulmonary pathology was diagnosed in 306 patients (33.7 ± 1.6%): pneumocystis pneumonia in 124 (13.7 ± 1.1%), primary pulmonary tuberculosis in 113 (12.5 ± 1.1%), bacterial pneumonia in 58 (6.4 ± 0.8%) toxoplasmosis pneumonia in two (0.2 ± 0.2%), and others. All patients were divided into two cohorts: 531 individuals seropositive for T. gondii and 376 seronegative ones. It has been found out that general lung pathology is more common in patients with seropositivity to T. gondii than in seronegative ones (43.3 ± 2.2% vs. 20.1 ± 2.0%, p < 0.001). The diagnosis of pneumocystis pneumonia was made ten times more often in the cohort of seropositive patients than in the cohort of seronegative ones (21.9 ± 1.8% vs. 2.1 ± 0.7%, respectively, p < 0.001) and in deceased patients of these cohorts it was 5.5 times more (45.1 ± 5.9% vs. 8.2 ± 3.9, respectively, p < 0.001). In patients with fatal outcome and seropositivity to T. gondii, the incidences of pneumocystis pneumonia increased by 23.2% (p < 0.001) and bacterial pneumonia by 12.4% (p < 0.05), whereas in seronegative individuals only pulmonary tuberculosis increased by 13.1% (p < 0.05) сompared with corresponding whole cohorts. Pearson's contingency coefficient showed the mean strength association between infection with T. gondii and incidence of pneumocystis pneumonia both in whole cohort (C = 0.272) and in patients with fatal outcomes (C = 0.368). In сonclusion, significantly increasing rate of pneumocystis pneumonia in patients with HIV/AIDS and T. gondii infection can be caused by certain synergism between T. gondii and Pneumocystis jirovecii and in some cases overdiagnosis pneumocystis pneumonia due to undiagnosed toxoplasmosis pneumonia.

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A rare case of pulmonary toxoplasmosis in a patient with undifferentiated inflammatory arthritis on chronic methotrexate and corticosteroid therapy

Cited by 5 publications

References 19 publications

Pulmonary and Renal Toxoplasmosis in an Immunocompetent Adult Patient

Pulmonary and Renal Toxoplasmosis in an Immunocompetent Adult Patient

Acute exacerbation of pulmonary toxoplasmosis during corticosteroid therapy for immune thrombocytopenia

Invasion with Toxoplasma gondii can promote pneumocystis pneumonia in individuals with HIV/AIDS

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