Late-onset cerebral toxoplasmosis after allogeneic hematopoietic stem cell transplantation

Ahmed M. Khalaf, Mahmoud A. Hashim, Mohammed Alsharabati, Kenneth Fallon, Joel K. Cure, Peter Pappas, Shin Mineishi, Ayman Saad

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Objective: Unusual clinical course Background: Toxoplasmosis is an uncommon but potentially fatal complication following allogeneic hematopoietic stem cell transplantation (HCT). Post-transplant toxoplasmosis is often a reactivation of prior infection and typically occurs within the first 6 months of transplant. Herein, we report that cerebral toxoplasmosis may occur 22 months after allogeneic hematopoietic stem cell transplantation. Case Report: We describe a case of cerebral toxoplasmosis that occurred 22 months after an allogeneic HCT while the patient was on aerosolized pentamidine for Pneumocystis jiroveci pneumonia (PCP) prophylaxis. The disease was only diagnosed after brain biopsy because of atypical MRI appearance of the cerebral lesion and negative Toxoplasma gondii IgG antibody test result in the cerebrospinal fluid (CSF). The patient received pyrimethamine and sulfadiazine treatment, with dramatic improvement after several months. The patient is alive 2 years after infection diagnosis, with no evidence of disease and is off Toxoplasma prophylaxis. Conclusions: Cerebral toxoplasmosis can occur late after allogeneic HCT while patients are on immunosuppression therapy, with atypical features on imaging studies and negative Toxoplasma gondii IgG antibody test result in the CSF. Pre-transplant serologic screening for T. gondii antibodies in allogeneic transplant candidates is warranted. Brain biopsy can be a helpful diagnostic tool for cerebral lesions.

Original languageEnglish (US)
Article number899687
Pages (from-to)246-250
Number of pages5
JournalAmerican Journal of Case Reports
Volume18
DOIs
StatePublished - Mar 10 2017

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Cerebral Toxoplasmosis
Hematopoietic Stem Cell Transplantation
Toxoplasma
Transplants
Toxoplasmosis
Cerebrospinal Fluid
Antibodies
Immunoglobulin G
Sulfadiazine
Pentamidine
Biopsy
Pneumocystis carinii
Pyrimethamine
Pneumocystis Pneumonia
Brain
Infection
Immunosuppression
Therapeutics

All Science Journal Classification (ASJC) codes

  • Medicine(all)

Cite this

Khalaf, A. M., Hashim, M. A., Alsharabati, M., Fallon, K., Cure, J. K., Pappas, P., ... Saad, A. (2017). Late-onset cerebral toxoplasmosis after allogeneic hematopoietic stem cell transplantation. American Journal of Case Reports, 18, 246-250. [899687]. https://doi.org/10.12659/AJCR.899687
Khalaf, Ahmed M. ; Hashim, Mahmoud A. ; Alsharabati, Mohammed ; Fallon, Kenneth ; Cure, Joel K. ; Pappas, Peter ; Mineishi, Shin ; Saad, Ayman. / Late-onset cerebral toxoplasmosis after allogeneic hematopoietic stem cell transplantation. In: American Journal of Case Reports. 2017 ; Vol. 18. pp. 246-250.
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abstract = "Objective: Unusual clinical course Background: Toxoplasmosis is an uncommon but potentially fatal complication following allogeneic hematopoietic stem cell transplantation (HCT). Post-transplant toxoplasmosis is often a reactivation of prior infection and typically occurs within the first 6 months of transplant. Herein, we report that cerebral toxoplasmosis may occur 22 months after allogeneic hematopoietic stem cell transplantation. Case Report: We describe a case of cerebral toxoplasmosis that occurred 22 months after an allogeneic HCT while the patient was on aerosolized pentamidine for Pneumocystis jiroveci pneumonia (PCP) prophylaxis. The disease was only diagnosed after brain biopsy because of atypical MRI appearance of the cerebral lesion and negative Toxoplasma gondii IgG antibody test result in the cerebrospinal fluid (CSF). The patient received pyrimethamine and sulfadiazine treatment, with dramatic improvement after several months. The patient is alive 2 years after infection diagnosis, with no evidence of disease and is off Toxoplasma prophylaxis. Conclusions: Cerebral toxoplasmosis can occur late after allogeneic HCT while patients are on immunosuppression therapy, with atypical features on imaging studies and negative Toxoplasma gondii IgG antibody test result in the CSF. Pre-transplant serologic screening for T. gondii antibodies in allogeneic transplant candidates is warranted. Brain biopsy can be a helpful diagnostic tool for cerebral lesions.",
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Khalaf, AM, Hashim, MA, Alsharabati, M, Fallon, K, Cure, JK, Pappas, P, Mineishi, S & Saad, A 2017, 'Late-onset cerebral toxoplasmosis after allogeneic hematopoietic stem cell transplantation', American Journal of Case Reports, vol. 18, 899687, pp. 246-250. https://doi.org/10.12659/AJCR.899687

Late-onset cerebral toxoplasmosis after allogeneic hematopoietic stem cell transplantation. / Khalaf, Ahmed M.; Hashim, Mahmoud A.; Alsharabati, Mohammed; Fallon, Kenneth; Cure, Joel K.; Pappas, Peter; Mineishi, Shin; Saad, Ayman.

In: American Journal of Case Reports, Vol. 18, 899687, 10.03.2017, p. 246-250.

Research output: Contribution to journalArticle

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AU - Khalaf, Ahmed M.

AU - Hashim, Mahmoud A.

AU - Alsharabati, Mohammed

AU - Fallon, Kenneth

AU - Cure, Joel K.

AU - Pappas, Peter

AU - Mineishi, Shin

AU - Saad, Ayman

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Y1 - 2017/3/10

N2 - Objective: Unusual clinical course Background: Toxoplasmosis is an uncommon but potentially fatal complication following allogeneic hematopoietic stem cell transplantation (HCT). Post-transplant toxoplasmosis is often a reactivation of prior infection and typically occurs within the first 6 months of transplant. Herein, we report that cerebral toxoplasmosis may occur 22 months after allogeneic hematopoietic stem cell transplantation. Case Report: We describe a case of cerebral toxoplasmosis that occurred 22 months after an allogeneic HCT while the patient was on aerosolized pentamidine for Pneumocystis jiroveci pneumonia (PCP) prophylaxis. The disease was only diagnosed after brain biopsy because of atypical MRI appearance of the cerebral lesion and negative Toxoplasma gondii IgG antibody test result in the cerebrospinal fluid (CSF). The patient received pyrimethamine and sulfadiazine treatment, with dramatic improvement after several months. The patient is alive 2 years after infection diagnosis, with no evidence of disease and is off Toxoplasma prophylaxis. Conclusions: Cerebral toxoplasmosis can occur late after allogeneic HCT while patients are on immunosuppression therapy, with atypical features on imaging studies and negative Toxoplasma gondii IgG antibody test result in the CSF. Pre-transplant serologic screening for T. gondii antibodies in allogeneic transplant candidates is warranted. Brain biopsy can be a helpful diagnostic tool for cerebral lesions.

AB - Objective: Unusual clinical course Background: Toxoplasmosis is an uncommon but potentially fatal complication following allogeneic hematopoietic stem cell transplantation (HCT). Post-transplant toxoplasmosis is often a reactivation of prior infection and typically occurs within the first 6 months of transplant. Herein, we report that cerebral toxoplasmosis may occur 22 months after allogeneic hematopoietic stem cell transplantation. Case Report: We describe a case of cerebral toxoplasmosis that occurred 22 months after an allogeneic HCT while the patient was on aerosolized pentamidine for Pneumocystis jiroveci pneumonia (PCP) prophylaxis. The disease was only diagnosed after brain biopsy because of atypical MRI appearance of the cerebral lesion and negative Toxoplasma gondii IgG antibody test result in the cerebrospinal fluid (CSF). The patient received pyrimethamine and sulfadiazine treatment, with dramatic improvement after several months. The patient is alive 2 years after infection diagnosis, with no evidence of disease and is off Toxoplasma prophylaxis. Conclusions: Cerebral toxoplasmosis can occur late after allogeneic HCT while patients are on immunosuppression therapy, with atypical features on imaging studies and negative Toxoplasma gondii IgG antibody test result in the CSF. Pre-transplant serologic screening for T. gondii antibodies in allogeneic transplant candidates is warranted. Brain biopsy can be a helpful diagnostic tool for cerebral lesions.

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Khalaf AM, Hashim MA, Alsharabati M, Fallon K, Cure JK, Pappas P et al. Late-onset cerebral toxoplasmosis after allogeneic hematopoietic stem cell transplantation. American Journal of Case Reports. 2017 Mar 10;18:246-250. 899687. https://doi.org/10.12659/AJCR.899687