Toxoplasmosis encephalitis following severe graft-vs.-host disease after allogeneic hematopoietic stem cell transplantation: 17 Yr experience in Fukuoka BMT group

Yayoi Matsuo, Shoichiro Takeishi, Toshihiro Miyamoto, Atsushi Nonami, Yoshikane Kikushige, Yuya Kunisaki, Kenjiro Kamezaki, Liping Tu, Hajime Hisaeda, Katsuto Takenaka, Naoki Harada, Tomohiko Kamimura, Yuju Ohno, Tetsuya Eto, Takanori Teshima, Hisashi Gondo, Mine Harada, Koji Nagafuji

Research output: Contribution to journalArticle

35 Citations (Scopus)

Abstract

Toxoplasmosis is a rare but rapidly fatal complication that can occur following hematopoietic stem cell transplantation (HSCT). Over a 17-yr period at our institutions, a definite diagnosis of toxoplasmosis was made in only two of 925 allogeneic HSCT recipients (0.22%) and none of 641 autologous HSCT recipients. These two patients received a conventional conditioning regimen followed by transplantation from an HLA-matched donor; however, they developed severe graft-vs.-host disease, which required intensive immunosuppressive therapy. Despite prophylactic treatment with trimethoprim/sulfamethoxazole, their immunosuppressive state, as indicated by a low CD4+ cell count, might have resulted in toxoplasmosis encephalitis. Rapid and non-invasive methods such as a polymerase chain reaction (PCR) test of their cerebrospinal fluid for Toxoplasma gondii and magnetic resonance imaging of the brain were useful for providing a definitive diagnosis and prompt therapy in these patients: one patient stabilized and survived after responding to treatment with pyrimethamine/sulfodiazine whereas the other died of bacterial infection. In addition, retrospective PCR analyses of the frozen stored peripheral blood samples disclosed that detection of T. gondii preceded the onset of disease, indicating routine PCR testing of peripheral blood specimens may be an early diagnostic tool. It should be noted that when patients receiving HSCT have an unexplained fever and/or neurological complications, PCR tests should be considered to avoid cerebral lesions and improve the outcome of the patients.

Original languageEnglish
Pages (from-to)317-321
Number of pages5
JournalEuropean Journal of Haematology
Volume79
Issue number4
DOIs
Publication statusPublished - Oct 1 2007

All Science Journal Classification (ASJC) codes

  • Hematology

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