title: Unusual presentation of primary toxoplasmosis infection in a kidney-transplant patient complicated by an acute left-ventricular failure.
abstract: Although primary toxoplasmosis is a rare event following kidney transplantation, it can be life threatening. This report describes this complication. The patient presented with high-grade fever, haemolytic anaemia and haemophagocytic-syndrome-related pancytopaenia. Toxoplasma gondii diagnosis was ascertained by blood and bone-marrow PCR assays. After 6 weeks with Clindamycin plus pyrimethamine therapies and despite negativation of T. gondii blood PCR assay, the patient developed left-ventricular failure. After adding sulfamethoxazole/ trimethoprim, ramipril, digoxine, bisoprolol and spironolactone, he progressively recovered. Anti-T. gondii therapy was continued for 6 months. Four years later he received a third kidney allograft: at that time anti-T. gondii antibodies had become negative. The outcome was uneventful despite immunosuppression but with inclusion of sulfamethoxazole/trimethoprim prophylaxis. More than 3 years after the third kidney transplantation the patient has had no toxoplasmosis reactivation. This case report highlights that T. gondii can be the cause of myocarditis in a renal transplant recipient.
authors.affiliation: Department of Nephrology, Dialysis and Multiorgan Transplantation , University Hospital , CHU Rangueil.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Hébraud
authors.forename: Nassim
authors.initials: N
authors.lastname: Kamar
authors.forename: Jean-Sébastien
authors.initials: JS
authors.lastname: Borde
authors.forename: Marie-Hélène
authors.initials: MH
authors.lastname: Bessières
authors.forename: Michel
authors.initials: M
authors.lastname: Galinier
authors.forename: Lionel
authors.initials: L
authors.lastname: Rostaing