title: Early diagnosis and successful treatment of disseminated toxoplasmosis after cord blood transplantation.
abstract: A 66-year-old woman with refractory angioimmunoblastic T-cell lymphoma underwent cord blood transplantation. Prior to transplantation, a serological test for Toxoplasma gondii-specific IgG antibodies was positive. On day 96, she exhibited fever and dry cough. Chest CT showed diffuse centrilobular ground glass opacities in both lungs. The reactivation of T. gondii was identified by the presence of parasite DNA in peripheral blood and bronchoalveolar lavage fluid. Moreover, brain MRI revealed a space occupying lesion in the right occipital lobe. Therefore, disseminated toxoplasmosis was diagnosed. She received pyrimethamine and sulfadiazine from day 99. The lung and brain lesions both showed improvement but the PCR assay for T. gondii DNA in peripheral blood was positive on day 133. On day 146, she developed blurred vision and reduced visual acuity, and a tentative diagnosis of toxoplasmic retinochoroiditis was made based on ophthalmic examination results. As agranulocytosis developed on day 158, we decided to discontinue pyrimethamine and sulfadiazine and the treatment was thus switched to atovaquone. Moreover, we added spiramycin to atovaquone therapy from day 174, and her ocular condition gradually improved. In general, the prognosis of disseminated toxoplasmosis after hematopoietic stem cell transplantation (HSCT) is extremely poor. However, early diagnosis and treatment may contribute to improvement of the fundamentally dismal prognosis of disseminated toxoplasmosis after HSCT.
authors.affiliation: Department of Hematology, Nagano Red Cross Hospital.
authors.forename: Taro
authors.initials: T
authors.lastname: Kurihara
authors.forename: Masahiko
authors.initials: M
authors.lastname: Sumi
authors.forename: Hiroko
authors.initials: H
authors.lastname: Kaiume
authors.forename: Wataru
authors.initials: W
authors.lastname: Takeda
authors.forename: Takehiko
authors.initials: T
authors.lastname: Kirihara
authors.forename: Keijiro
authors.initials: K
authors.lastname: Sato
authors.forename: Toshimitsu
authors.initials: T
authors.lastname: Ueki
authors.forename: Yuki
authors.initials: Y
authors.lastname: Hiroshima
authors.forename: Mayumi
authors.initials: M
authors.lastname: Ueno
authors.forename: Naoaki
authors.initials: N
authors.lastname: Ichikawa
authors.forename: Yumi
authors.initials: Y
authors.lastname: Kaneko
authors.forename: Kenji
authors.initials: K
authors.lastname: Hikosaka
authors.forename: Kazumi
authors.initials: K
authors.lastname: Norose
authors.forename: Hikaru
authors.initials: H
authors.lastname: Kobayashi
mesh_terms: D000368:Aged; D000981:Antiprotozoal Agents / Q000627:therapeutic use; D004338:Drug Combinations; D042241:Early Diagnosis; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects; D006801:Humans; D014122:Toxoplasma / Q000187:drug effects; D014123:Toxoplasmosis / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology
chemical_list: D000981:Antiprotozoal Agents; D004338:Drug Combinations