title: 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.
abstract: 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.
authors.affiliation: Department of Hematology, Heartlife Hospital, Okinawa, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Miyagi
authors.affiliation: Department of Hematology, Sasebo City General Hospital, Sasebo, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Itonaga
authors.affiliation: Department of Infection and Host Defense, Graduate School of Medicine, Chiba University, Chiba, Japan.|Department of Infection and Host Defense, Graduate School of Medicine, Shinshu University, Matsumoto, Japan.
authors.forename: F
authors.initials: F
authors.lastname: Aosai
authors.affiliation: Department of Hematology, Atomic Bomb Disease and Hibakusha Medicine Unit, Atomic Bomb Disease Institute, Nagasaki University, Nagasaki City, Japan.
authors.forename: J
authors.initials: J
authors.lastname: Taguchi
authors.affiliation: Department of Infection and Host Defense, Graduate School of Medicine, Chiba University, Chiba, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Norose
authors.affiliation: Department of Infectious Disease, Nagasaki University Hospital, Nagasaki, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Mochizuki
authors.affiliation: Department of Infectious Disease, Nagasaki University Hospital, Nagasaki, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Fujii
authors.affiliation: Department of Infectious Disease, Nagasaki University Hospital, Nagasaki, Japan.
authors.forename: A
authors.initials: A
authors.lastname: Furumoto
authors.affiliation: Department of Hematology, Heartlife Hospital, Okinawa, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Ohama
authors.affiliation: Department of Hematology, Heartlife Hospital, Okinawa, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Karimata
authors.affiliation: Department of Hematology, Heartlife Hospital, Okinawa, Japan.
authors.forename: A
authors.initials: A
authors.lastname: Yamanoha
authors.affiliation: Department of Hematology, Sasebo City General Hospital, Sasebo, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Taniguchi
authors.affiliation: Department of Hematology, Sasebo City General Hospital, Sasebo, Japan.
authors.forename: S
authors.initials: S
authors.lastname: Sato
authors.affiliation: Department of Hematology, Heartlife Hospital, Okinawa, Japan.
authors.forename: N
authors.initials: N
authors.lastname: Taira
authors.affiliation: Department of Hematology, Sasebo City General Hospital, Sasebo, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Moriuchi
authors.affiliation: Laboratory of Hematoimmunology, Department of Clinical Laboratory Sciences, School of Health Sciences, Faculty of Medicine, University of the Ryukyus, Okinawa, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Fukushima
authors.affiliation: Division of Endocrinology, Diabetes and Metabolism, Hematology, Rheumatology (Second Department of Medicine), Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Masuzaki
authors.affiliation: Department of Hematology, Atomic Bomb Disease and Hibakusha Medicine Unit, Atomic Bomb Disease Institute, Nagasaki University, Nagasaki City, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Miyazaki
mesh_terms: D000328:Adult; D000981:Antiprotozoal Agents / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D042241:Early Diagnosis; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D000069544:Infectious Encephalitis / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D015470:Leukemia, Myeloid, Acute / Q000150:complications / Q000628:therapy; D008297:Male; D009894:Opportunistic Infections / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D016133:Polymerase Chain Reaction; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications / Q000628:therapy; D011739:Pyrimethamine / Q000627:therapeutic use*; D013411:Sulfadiazine / Q000627:therapeutic use*; D016781:Toxoplasmosis, Cerebral / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D014184:Transplantation, Homologous
chemical_list: D000981:Antiprotozoal Agents; D013411:Sulfadiazine; D011739:Pyrimethamine
keywords: Toxoplasma gondii; allogeneic hematopoietic stem cell transplantation; encephalitis