[Non-Hodgkin's lymphoma with Toxoplasma encephalitis].
A 62-year-old man was admitted to our hospital due to fever and systemic lymph-node swelling on June 9, 1998. He was given a diagnosis of non-Hodgkin's lymphoma (diffuse mixed T cell lymphoma) with involvement of mediastinum and para-aortic lymph nodes, pleura, peritoneum, and bone marrow. After diagnosis, combined chemotherapy (CHOP regimen) was started. On day 11, the patient's consciusness level suddenly deteriorated. A brain computed tomographic scan showed no abnormal findings. A cytospin smear of cerebrospinal fluid disclosed tachyzoides (Toxoplasmic bodies), thus yielding a diagnosis of Toxoplasma encephalitis. Oral sulfadoxine pyrimethamine rapidly alleviated the patient's consciousness disturbance. One month later, a cytospin smear and RT-PCR analysis of cerebrospinal fluid detected no tachyzoides. Complete remission of lymphoma was achieved after 2 courses of CHOP therapy. Toxoplasma encephalitis should be considered a potential cause of consciousness disturbance in immunocompromised hosts, such as patients with malignant lymphoma. Cytospin smears of cerebrospinal fluid are a useful tool for the early diagnosis of Toxoplasma encephalitis.
Yoshimura
K
K
First Department of Internal Medicine, Gifu University School of Medicine.
Hara
T
T
Tsurumi
H
H
Goto
H
H
Tajika
M
M
Fukutomi
Y
Y
Murakami
N
N
Moriwaki
H
H
D000818:Animals; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D000981:Antiprotozoal Agents / Q000008:administration & dosage; D003520:Cyclophosphamide / Q000008:administration & dosage; D004317:Doxorubicin / Q000008:administration & dosage; D004334:Drug Administration Schedule; D004338:Drug Combinations; D004660:Encephalitis / Q000188:drug therapy / Q000209:etiology / Q000469:parasitology*; D006801:Humans; D016399:Lymphoma, T-Cell / Q000150:complications* / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D011239:Prednisolone / Q000008:administration & dosage; D011739:Pyrimethamine / Q000008:administration & dosage; D012074:Remission Induction; D013413:Sulfadoxine / Q000008:administration & dosage; D016781:Toxoplasmosis, Cerebral / Q000188:drug therapy / Q000209:etiology / Q000469:parasitology*; D014750:Vincristine / Q000008:administration & dosage
D000981:Antiprotozoal Agents; D004338:Drug Combinations; C001205:fanasil, pyrimethamine drug combination; D014750:Vincristine; D004317:Doxorubicin; D013413:Sulfadoxine; D003520:Cyclophosphamide; D011239:Prednisolone; D011739:Pyrimethamine