title: Cerebral toxoplasmosis in an adolescent post allogeneic hematopoietic stem cell transplantation: successful outcome by antiprotozoal chemotherapy and CD4+ T-lymphocyte recovery.
abstract: Toxoplasmosis is a rare opportunistic infection in pediatric allogeneic hematopoietic stem cell transplant (allo-HSCT) recipients and associated with severe T-cell deficiency. Here, we report the successful management of cerebral toxoplasmosis in a 15-year-old adolescent 4 months post allo-HSCT for non-Hodgkin lymphoma through rapid invasive diagnostics, long-term antiprotozoal chemotherapy, and an hematopoietic stem cell boost for persistently poor graft function. While supportive care and antiprotozoal chemotherapy achieved stabilization, definite improvement only occurred following recovery of CD4(+) T lymphocytes to >100 cells/μL. At 5 years after the diagnosis of toxoplasmosis, the patient is in continuing remission with normalized clinical and imaging findings.
authors.affiliation: Department of Pediatric Hematology and Oncology, University Children's Hospital Muenster, Muenster, Germany.
authors.forename: K
authors.initials: K
authors.lastname: Kerl
authors.forename: K
authors.initials: K
authors.lastname: Ehlert
authors.forename: A
authors.initials: A
authors.lastname: Brentrup
authors.forename: M
authors.initials: M
authors.lastname: Schiborr
authors.forename: K
authors.initials: K
authors.lastname: Keyvani
authors.forename: K
authors.initials: K
authors.lastname: Becker
authors.forename: C
authors.initials: C
authors.lastname: Rossig
authors.forename: A H
authors.initials: AH
authors.lastname: Groll
mesh_terms: D000293:Adolescent; D000981:Antiprotozoal Agents / Q000627:therapeutic use*; D015496:CD4-Positive T-Lymphocytes; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D016867:Immunocompromised Host; D008228:Lymphoma, Non-Hodgkin / Q000601:surgery*; D009894:Opportunistic Infections / Q000188:drug therapy; D014122:Toxoplasma / Q000187:drug effects*; D016781:Toxoplasmosis, Cerebral / Q000188:drug therapy*; D014184:Transplantation, Homologous; D016896:Treatment Outcome
chemical_list: D000981:Antiprotozoal Agents
keywords: Toxoplasma gondii; cancer; children; immunotherapy; outcome; toxoplasmosis; treatment