title: Clinical characteristics and computed tomography findings of pulmonary toxoplasmosis after hematopoietic stem cell transplantation.
abstract: The prognosis of pulmonary toxoplasmosis, including disseminated toxoplasmosis involving the lungs, following hematopoietic stem cell transplantation (HSCT) is extremely poor due to the difficulties associated with early diagnosis and the rapidly progressive deterioration of multiorgan function. In our institution, we identified nine cases of toxoplasmosis, representing incidences of 2.2 and 19.6 % among all HSCT recipients and seropositive HSCT recipients, respectively. Of the patients with toxoplasmosis, six had pulmonary toxoplasmosis. Chest computed tomography (CT) findings revealed centrilobular, patchy ground-glass opacities (n = 3), diffuse ground-glass opacities (n = 2), ground-glass opacities with septal thickening (n = 1), and marked pleural effusion (n = 1). All cases died, except for one with suspected pulmonary toxoplasmosis who was diagnosed by a polymerase chain reaction assay 2 days after the onset of symptoms. In pulmonary toxoplasmosis, CT findings are non-specific and may mimic pulmonary congestion, atypical pneumonia, viral pneumonitis, and bronchopneumonia. Early diagnosis and treatment is crucial for overcoming this serious infectious complication. Pulmonary toxoplasmosis should be considered during differential diagnosis in a recipient with otherwise unexplained signs of infection and CT findings with ground-glass opacities, regardless of the distribution.
authors.affiliation: Department of Hematology, Nagano Red Cross Hospital, 5-22-1 Wakasato, Nagano City, Nagano, 380-8582, Japan. sumin@nagano-med.jrc.or.jp.
authors.forename: Masahiko
authors.identifier: http://orcid.org/0000-0002-4535-7922
authors.initials: M
authors.lastname: Sumi
authors.affiliation: Department of Infection and Host Defense, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan.
authors.forename: Kazumi
authors.initials: K
authors.lastname: Norose
authors.affiliation: Department of Infection and Host Defense, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Hikosaka
authors.affiliation: Department of Hematology, Nagano Red Cross Hospital, 5-22-1 Wakasato, Nagano City, Nagano, 380-8582, Japan.
authors.forename: Hiroko
authors.initials: H
authors.lastname: Kaiume
authors.affiliation: Department of Hematology, Nagano Red Cross Hospital, 5-22-1 Wakasato, Nagano City, Nagano, 380-8582, Japan.
authors.forename: Wataru
authors.initials: W
authors.lastname: Takeda
authors.affiliation: Department of Hematology, Nagano Red Cross Hospital, 5-22-1 Wakasato, Nagano City, Nagano, 380-8582, Japan.
authors.forename: Takehiko
authors.initials: T
authors.lastname: Kirihara
authors.affiliation: Department of Hematology, Nagano Red Cross Hospital, 5-22-1 Wakasato, Nagano City, Nagano, 380-8582, Japan.
authors.forename: Taro
authors.initials: T
authors.lastname: Kurihara
authors.affiliation: Department of Hematology, Nagano Red Cross Hospital, 5-22-1 Wakasato, Nagano City, Nagano, 380-8582, Japan.
authors.forename: Keijiro
authors.initials: K
authors.lastname: Sato
authors.affiliation: Department of Hematology, Nagano Red Cross Hospital, 5-22-1 Wakasato, Nagano City, Nagano, 380-8582, Japan.
authors.forename: Toshimitsu
authors.initials: T
authors.lastname: Ueki
authors.affiliation: Department of Hematology, Nagano Red Cross Hospital, 5-22-1 Wakasato, Nagano City, Nagano, 380-8582, Japan.
authors.forename: Yuki
authors.initials: Y
authors.lastname: Hiroshima
authors.affiliation: Respiratory Division, Nagano Red Cross Hospital, 5-22-1 Wakasato, Nagano City, 380-8582, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kuraishi
authors.affiliation: Department of Pathology, Nagano Red Cross Hospital, 5-22-1 Wakasato, Nagano City, 380-8582, Japan.
authors.forename: Masahide
authors.initials: M
authors.lastname: Watanabe
authors.affiliation: Department of Hematology, Nagano Red Cross Hospital, 5-22-1 Wakasato, Nagano City, Nagano, 380-8582, Japan.
authors.forename: Hikaru
authors.initials: H
authors.lastname: Kobayashi
mesh_terms: D000328:Adult; D000368:Aged; D000977:Antiparasitic Agents / Q000627:therapeutic use; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging* / Q000469:parasitology*; D008174:Lung Diseases, Parasitic / Q000097:blood / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000209:etiology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D014122:Toxoplasma / Q000187:drug effects / Q000302:isolation & purification*; D014123:Toxoplasmosis / Q000097:blood / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000209:etiology; D055815:Young Adult
chemical_list: D000977:Antiparasitic Agents
keywords: Disseminated toxoplasmosis; Pulmonary toxoplasmosis; Stem cell transplantation; Toxoplasma gondii