Cerebral Toxoplasmosis in a Diffuse Large B Cell Lymphoma Patient

Savšek, Lina; Opaskar, Tanja Ros

doi:10.2478/raon-2014-004

Cited by 1 publication

(1 citation statement)

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“…In one previous report, concurrent progressive multifocal leukencephalopathy and cerebral toxoplasmosis developed in a patient with chronic lymphocytic leukaemia following therapy with rituximab, cyclophosphamide and fludarabine (Desmond et al, 2010). A second report described a patient who developed toxoplasmic encephalitis during treatment for diffuse large B-cell lymphoma with multiple rituximab-containing chemotherapy regimens (Savsek & Opaskar, 2014). Outside of these, the recognition of the association between cerebral toxoplasmosis and biological agents has been limited to three case reports of patients afflicted with underlying rheumatologic disorders, only one of whom received rituximab (Safa & Darrieux, 2013).…”

Section: Discussionmentioning

confidence: 99%

Cerebral toxoplasmosis after rituximab therapy for splenic marginal zone lymphoma: a case report and review of the literature

2015

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Introduction: Toxoplasma gondii is a parasite estimated to infect one-third of the global population, surviving in tissues in a latent form. Although cerebral toxoplasmosis is predominantly recognized as an opportunistic infection in hosts immunocompromised secondary to human immunodeficiency virus or bone marrow transplant, there is increasing recognition that this infection can occur in patients receiving immunomodulating agents such as mAb therapy targeted against T-cells, B-cells and TNF. The indications for these therapies are expanding, resulting in a larger at-risk population for this rare but serious and potentially avoidable complication. Case Presentation: This is one of the few case reports of cerebral toxoplasmosis following rituximab-based chemotherapy in a patient with a haematological malignancy. We describe a patient presenting with focal neurological deficits and radiographic evidence of multi-focal cerebral ring-enhancing lesions following completion of rituximab therapy for splenic marginal zone lymphoma. Brain biopsy confirmed a diagnosis of cerebral toxoplasmosis. Antibiotic treatment with trimethoprim/sulfamethoxazole resulted in near-complete radiological and clinical resolution of the neurological deficits, and a return to baseline functional status. Conclusion: Reactivation of toxoplasmosis resulting in intracerebral disease is a potential severe and preventable complication of rituximab therapy. Further studies are required to assess the need both for screening and prescribing primary chemoprophylaxis for toxoplasmosis when initiating rituximab therapy.

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Section: Discussionmentioning

confidence: 99%