Reactions 1704, p272 - 2 Jun 2018
Cerebral toxoplasmosis and associated
complications: case report
A 72-year-old man developed cerebral toxoplasmosis,
necrosis of brain tissue, ataxia, urinary incontinence and septic
shock during treatment with tacrolimus, mycophenolate
mofetil [Cellcept] and prednisolone [dosages, routes and
durations of treatments to reactions onsets not stated].
The man who had undergone right kidney transplantation,
was transferred to the hospital due to urinary incontinence and
ataxia for about 3 weeks. He was receiving treatment with
prednisolone, tacrolimus and mycophenolate mofetil. A
physical examination was significant for a pulse rate of
78 /min, temperature 36°C, BP of 112/86mm Hg, respiratory
rate of 20 /min. Laboratory testing showed normocytic
anaemia and leucocytosis. A brain MRI scan revealed at least
four lobulated nodular lesions over both right and frontal
temporal lobes with marked perifocal oedema and rim-
enhancement. He was admitted and a stereotactic brain
biopsy was performed, which demonstrated necrosis of the
brain tissue with a few macrophages, neutrophils and nuclear
debris. The biopsy tissue was negative for acid fast stain and
bacterial culture. Nocardiosis, toxoplasmosis or other fungal
infection was suspected due to chronic immunosuppression
for right kidney transplantation. Paired Toxoplasma
immunoglobulin G and immunoglobulin M were negative. A
brain MRI scan showed enlargement of the right frontal region.
A whole body positron emission tomography scan showed a
tiny nodule in the posterior segment of right upper lung and
multiple brain lesions, mainly right cerebrum with mass effect.
The man received treatment with cotrimoxazole
[sulfamethoxazole/trimethoprim] for possible cerebral
toxoplasmosis. Subsequently, the patient developed
hyperkalaemia and was transferred to the surgical ICU.
Cotrimoxazole treatment was withdrawn and he underwent
craniotomy with tumour resection. Haemodialysis was
performed after the operation. However, he developed septic
shock and his condition deteriorated. He was discharged on
day 22 due to terminal status. Tachyzoites were observed in
the necrotic brain tissue. A diagnosis of toxoplasmosis was
confirmed after Toxoplasma immunohistochemistry, periodic
acid-Schiff stain and Grocott’s methenamine silver stain.
Author comment: " Immunodeficiency is a known risk
factor of cerebral toxoplasmosis. Causes of immunodeficiency
include usage of immunosuppressants." "Long term
immunosuppressants after kidney transplantation led to
immunodeficiency in our patient, which became the risk
factor of the infection of Toxoplasma gondii"
Lu P-C, et al. Cerebral toxoplasmosis in a patient who had kidney transplant.
International Journal of Antimicrobial Agents 50 (Suppl. 2): S200, Nov 2017
[abstract] - Taiwan
Reactions 2 Jun 2018 No. 17040114-9954/18/1704-0001/$14.95 Adis © 2018 Springer International Publishing AG. All rights reserved