Successful treatment of toxoplasmic encephalitis diagnosed early by polymerase chain reaction after allogeneic hematopoietic stem cell transplantation: two case reports and review of the literature

Transpl Infect Dis. 2015 Aug;17(4):593-8. doi: 10.1111/tid.12401. Epub 2015 Jun 26.

Abstract

Toxoplasmic encephalitis represents a rare, but often fatal infection after allogeneic hematopoietic stem cell transplantation. Polymerase chain reaction (PCR)-based preemptive therapy is considered promising for this disease, but is not routinely applied, especially in low seroprevalence countries including Japan. We encountered 2 cases of toxoplasmic encephalitis after transplantation that were successfully treated. The diagnosis of toxoplasmic encephalitis in these cases was confirmed by PCR testing when neurological symptoms were observed. Both patients received pyrimethamine and sulfadiazine treatments within 2 weeks of the development of neurological symptoms, and remained free of recurrence for 32 and 12 months. These results emphasized the importance of the PCR test and immediate treatment after diagnosis for the management of toxoplasmic encephalitis.

Keywords: Toxoplasma gondii; allogeneic hematopoietic stem cell transplantation; encephalitis.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Adult
  • Antiprotozoal Agents / therapeutic use*
  • Drug Therapy, Combination
  • Early Diagnosis
  • Hematopoietic Stem Cell Transplantation*
  • Humans
  • Infectious Encephalitis / complications
  • Infectious Encephalitis / diagnosis
  • Infectious Encephalitis / drug therapy*
  • Leukemia, Myeloid, Acute / complications
  • Leukemia, Myeloid, Acute / therapy
  • Male
  • Opportunistic Infections / complications
  • Opportunistic Infections / diagnosis
  • Opportunistic Infections / drug therapy*
  • Polymerase Chain Reaction
  • Precursor Cell Lymphoblastic Leukemia-Lymphoma / complications
  • Precursor Cell Lymphoblastic Leukemia-Lymphoma / therapy
  • Pyrimethamine / therapeutic use*
  • Sulfadiazine / therapeutic use*
  • Toxoplasmosis, Cerebral / complications
  • Toxoplasmosis, Cerebral / diagnosis
  • Toxoplasmosis, Cerebral / drug therapy*
  • Transplantation, Homologous

Substances

  • Antiprotozoal Agents
  • Sulfadiazine
  • Pyrimethamine