Severe Pulmonary Toxoplasmosis Mimicking Viral Pneumonitis after a Third Allogeneic Stem Cell Transplantation in a Man with Acute Lymphoblastic Leukemia

Sumi, Masahiko; Hata, Satoru; Sato, Keijiro; Fujikawa, Yuko; Shimizu, Ikuo; Ueki, Tomoyuki; Akahane, Daigo; Ueno, Makoto; Ichikawa, Naoaki; Kobayashi, Hikaru

doi:10.2169/internalmedicine.51.7837

Cited by 9 publications

(6 citation statements)

References 17 publications

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“…Toxoplasmosis is a rare, but potentially life‐threatening opportunistic infection, with an estimated mortality rate of 60–90%, after allogeneic hematopoietic stem cell transplantation (allo‐SCT) , and has been attributed to the reactivation of latent Toxoplasma gondii infection . The seroprevalence of T. gondii varies markedly among different regions, ranging from 10% to 50–80%; 10% in Japan, <15% in the United States, and 50–80% in Central Europe .…”

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confidence: 99%

Successful treatment of toxoplasmic encephalitis diagnosed early by polymerase chain reaction after allogeneic hematopoietic stem cell transplantation: two case reports and review of the literature

Miyagi

Itonaga

Aosai

et al. 2015

Transplant Infectious Dis

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Toxoplasmic encephalitis represents a rare, but often fatal infection after allogeneic hematopoietic stem cell transplantation. Polymerase chain reaction (PCR)-based preemptive therapy is considered promising for this disease, but is not routinely applied, especially in low seroprevalence countries including Japan. We encountered 2 cases of toxoplasmic encephalitis after transplantation that were successfully treated. The diagnosis of toxoplasmic encephalitis in these cases was confirmed by PCR testing when neurological symptoms were observed. Both patients received pyrimethamine and sulfadiazine treatments within 2 weeks of the development of neurological symptoms, and remained free of recurrence for 32 and 12 months. These results emphasized the importance of the PCR test and immediate treatment after diagnosis for the management of toxoplasmic encephalitis.

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confidence: 99%

Successful treatment of toxoplasmic encephalitis diagnosed early by polymerase chain reaction after allogeneic hematopoietic stem cell transplantation: two case reports and review of the literature

Miyagi

Itonaga

Aosai

et al. 2015

Transplant Infectious Dis

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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%

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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“…11,15 Although the seroprevalence of T. gondii is low and thus the incidence of toxoplasmosis is low in Japan, there have been several reports by Japanese investigators showing the ominous prognosis of toxoplasmosis, especially disseminated disease, developing after allogeneic HSCT. 11,15,16 Therefore, there is a specific guideline of 'Toxoplasmosis' from Japan Society for Hematopoietic Cell Transplantation presenting the details of the basic background and epidemiology, prevention, and treatment of toxoplasmosis after HSCT. In the guideline, prophylaxis using TMP/SMX is recommended for seropositive patients.…”

Section: Discussionmentioning

confidence: 99%

Toxoplasmosis after allogeneic hematopoietic stem cell transplantation: Impact of serostatus‐based management

Amikura

Kikuchi

Kato

et al. 2020

Transplant Infectious Dis

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Toxoplasmosis is one of the potential life-threatening infectious complications after allogeneic hematopoietic stem cell transplantation (HSCT). 1 Since most cases of toxoplasmosis are caused by the reactivation of the parasite Toxoplasma gondii (T. gondii), its incidence is dependent on the seroprevalence of the patient population.In areas of high seroprevalence such as Europe and Latin America, post-transplant toxoplasmosis is well recognized and studied. In a prospective study performed in Europe, the incidence of T. gondii reactivation detected by polymerase chain reaction (PCR) was 16% in T. gondii-seropositive patients after allogeneic HSCT, and 38% of reactivated patients developed invasive toxoplasmosis. 2 Because of this reactivation incidence, physicians rarely encounter cases of toxoplasmosis in patient populations with a low seroprevalence.The universally used method to identify the patients at risk for developing toxoplasmosis is the determination of the IgG antibody titer for T. gondii before transplantation, as recommended by

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Severe Pulmonary Toxoplasmosis Mimicking Viral Pneumonitis after a Third Allogeneic Stem Cell Transplantation in a Man with Acute Lymphoblastic Leukemia

Cited by 9 publications

References 17 publications

Successful treatment of toxoplasmic encephalitis diagnosed early by polymerase chain reaction after allogeneic hematopoietic stem cell transplantation: two case reports and review of the literature

Successful treatment of toxoplasmic encephalitis diagnosed early by polymerase chain reaction after allogeneic hematopoietic stem cell transplantation: two case reports and review of the literature

Acute exacerbation of pulmonary toxoplasmosis during corticosteroid therapy for immune thrombocytopenia

Toxoplasmosis after allogeneic hematopoietic stem cell transplantation: Impact of serostatus‐based management

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