title: [Toxoplasmosis peri-myocarditis as initial manifestation of highly malignant non-Hodgkin's lymphoma].
abstract: A case report of a 28-year-old mother of two children with FUO is presented. Physical examination revealed an anemic and febrile woman, who lost 10 kg of weight during the past 3 months. Furthermore, two lymphatic nodes with diameters below 1 cm were detected at the neck and inguinal region. A search for origin of fever including evaluation of foci, malignancies and laboratory investigations was primarily unsuccessful. At day 7 after admission a pericardial murmur could be heard. Echocardiography revealed a pericardial effusion, which increased up to 4 cm during the following days, leading to hemodynamic impairment and asystole. Immediate CR was successful, pericardial effusion was aspirated. Looking for etiology of fever the presence of IgM-antibodies against toxoplasma gondii by an ELISA test was possible. Therefore, toxoplasmosis was diagnosed and a treatment-regimen comprising pyrimethamin and sulfadiazin was initiated. Because of the threat to life and very high titers of C-reactive protein, antibiotic therapy (imipenem) was given additionally. An immunologic impairment was excluded by normal ratio of CD4:CD8 of lymphocytes, normal HIV-test and a nonsuspicious Jamshidi-biopsy of the bone marrow. However, in week 9 after admission lymphatic node-tumors suddenly appeared at the neck and pulmonary hilus. After diagnostic exstirpation a malignant non-Hodgkin-lymphoma (T-cell-type) was diagnosed. It is concluded that in obscure pericardial effusion toxoplasmosis should be considered and that this manifestation may be a precursor of malignant non-Hodgkin-lymphoma.
authors.affiliation: Medizinische Universitätsklinik Graz.
authors.forename: R
authors.initials: R
authors.lastname: Zweiker
authors.forename: B
authors.initials: B
authors.lastname: Eber
authors.forename: H
authors.initials: H
authors.lastname: Samonigg
authors.forename: E C
authors.initials: EC
authors.lastname: Reisinger
authors.forename: A
authors.initials: A
authors.lastname: Kasparek
authors.forename: M
authors.initials: M
authors.lastname: Schumacher
authors.forename: F M
authors.initials: FM
authors.lastname: Fruhwald
authors.forename: U
authors.initials: U
authors.lastname: Apfelbeck
authors.forename: W
authors.initials: W
authors.lastname: Klein
mesh_terms: D000328:Adult; D001706:Biopsy; D003937:Diagnosis, Differential; D003952:Diagnostic Imaging; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology; D017728:Lymphoma, Large-Cell, Anaplastic / Q000150:complications* / Q000175:diagnosis; D016399:Lymphoma, T-Cell / Q000150:complications* / Q000175:diagnosis; D009205:Myocarditis / Q000175:diagnosis*; D009367:Neoplasm Staging; D009894:Opportunistic Infections / Q000175:diagnosis*; D010493:Pericarditis / Q000175:diagnosis*; D014123:Toxoplasmosis / Q000175:diagnosis*
vernacular_title: Toxoplasmose-Peri-Myokarditis als Erstmanifestation eines hochmalignen Non-Hodgkin-Lymphoms.