Infect Chemother.  2010 Jun;42(3):181-186. 10.3947/ic.2010.42.3.181.

A Case of Cerebral Toxoplasmosis Following Tandem Autologous Stem Cell Transplantation in a Multiple Myeloma Patient

• Kim KH
• Song KH
• Jeon JH
• Park WB
• Park SW
• Kim HB
• Kim NJ
• Kim I
• Oh MD

• KMID: 2170307
• DOI: http://doi.org/10.3947/ic.2010.42.3.181

Abstract

Toxoplasmosis is a rare but fatal complication in hematopoietic stem cell transplant recipients, usually associated with allogeneic hematopoietic stem cell transplantation (HSCT). We report a case of cerebral toxoplasmosis in a patient with multiple myeloma, following tandem autologous stem cell transplantation. A 55-year-old Korean male presented with weakness in both legs that had progressed to both arms. A magnetic resonance imaging scan of the brain revealed multiple, variable-sized ring-enhancing lesions with surrounding edema in the cerebral hemispheres and brain stem. Stereotactic biopsy revealed bradyzoites of Toxoplasma gondii in the brain tissue. The patient received trimethoprim-sulfamethoxazole, followed by pyrimethamine and sulfadiazine, accompanying treatment for progressive multiple myeloma. Cerebral toxoplasmosis should be considered as one of the differential diagnoses in patients with neurologic signs following autologous HSCT.

Keyword

Toxoplasmosis; Cerebral; Stem cell transplantation; Autologous; Multiple myeloma

MeSH Terms

Arm
Biopsy
Brain
Brain Stem
Cerebrum
Diagnosis, Differential
Edema
Hematopoietic Stem Cell Transplantation
Hematopoietic Stem Cells
Humans
Leg
Magnetic Resonance Imaging
Male
Middle Aged
Multiple Myeloma
Neurologic Manifestations
Pyrimethamine
Stem Cell Transplantation
Stem Cells
Sulfadiazine
Toxoplasma
Toxoplasmosis
Toxoplasmosis, Cerebral
Trimethoprim, Sulfamethoxazole Drug Combination
Pyrimethamine
Sulfadiazine

Figure

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  Figure 1 MRI scans of the brain at the time of diagnosis of cerebral toxoplasmosis. Multiple variable-sized ring-enhancing lesions with surrounding edema are shown in the bilateral cerebral hemispheres and brainstem. Lesions of T1 high intensity (A) and T2 low intensity (B) suggest focal hemorrhage.

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  Figure 2 Biopsy of the brain tissue reveals a bradyzoite of T. gondii (arrow) (H&E, ×400).

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  Figure 3 MRI scans of the brain show that the size and numbers of ring-enhancing lesions reduced and surrounding edema decreased after treatment for 55 days.

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