title: Asymptomatic diffuse "encephalitic" cerebral toxoplasmosis in a woman with systemic lupus erythematosus.
abstract: Classic cerebral toxoplasmosis typically presents with neurologic symptoms such as seizures and mental status changes and histological examination shows focal lesions with necrosis. However, in the diffuse "encephalitic" form, patients are asymptomatic with diffuse, inflammatory, non-necrotic lesions. Asymptomatic diffuse "encephalitic" toxoplasmosis has been reported only in four acquired immunodeficiency syndrome patients and one human immunodeficiency virus (HIV) negative patient with chronic lymphocytic leukemia. We present a 36-year-old HIV-negative woman with systemic lupus erythematosus and lupus nephritis who was on immunosuppression for 9years after cadaveric renal transplant and died from pulmonary hemorrhage and cytomegalovirus pneumonia. Brain autopsy findings revealed multifocal microglial nodules containing Toxoplasma bradyzoites and associated astrogliosis. These nodules were prominent in the cerebellum, midbrain and medulla and also present in the cortex and thalamus. No coagulative necrosis, necrotizing abscesses, or other opportunistic infections were present. The patient had previously exhibited no neurologic symptoms and there was no clinical suspicion for toxoplasmosis. To the best of our knowledge, this is the first case of diffuse, non-necrotizing, "encephalitic" cerebral toxoplasmosis reported in a lupus patient and also the first reported female case.
authors.affiliation: Rush University Medical Center, 1750 W Harrison Street, Ste 570 Jelke, Chicago, IL 60661, USA. Electronic address: diana_murro@rush.edu.
authors.forename: Diana
authors.initials: D
authors.lastname: Murro
authors.affiliation: Rush University Medical Center, 1750 W Harrison Street, Ste 570 Jelke, Chicago, IL 60661, USA.
authors.forename: Jorge
authors.initials: J
authors.lastname: Novo
authors.affiliation: Rush University Medical Center, 1750 W Harrison Street, Ste 570 Jelke, Chicago, IL 60661, USA.
authors.forename: Leonidas
authors.initials: L
authors.lastname: Arvanitis
mesh_terms: D000328:Adult; D001344:Autopsy; D004660:Encephalitis / Q000276:immunology / Q000382:microbiology; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D016030:Kidney Transplantation; D008181:Lupus Nephritis / Q000150:complications* / Q000276:immunology; D009894:Opportunistic Infections / Q000276:immunology; D016781:Toxoplasmosis, Cerebral / Q000276:immunology*
keywords: Central nervous system; Renal transplant; Systemic lupus erythematosus; Toxoplasma; Toxoplasmosis