González M I, Caballero D, López C, Alburquerque T, Hernández R, de la Loma A, Cañizo C, Vázquez L, San Miguel J F
Servicio de Hematología, Hospital Clínico Universitario, Salamanca, Spain.
Transpl Infect Dis. 2000 Sep;2(3):145-9. doi: 10.1034/j.1399-3062.2000.020308.x.
We report an unusual case of cerebral toxoplasmosis associated with Guillain-Barré syndrome (GBS) in a 25-year-old patient diagnosed with chronic myelogenous leukaemia (CML), who underwent a mismatched allogeneic peripheral stem cell transplantation (PSCT). On day +83 he started with fever, and 7 days later tremor, muscular weakness, diplopia, dysarthria, respiratory difficulty, and universal arreflexia appeared, compatible with GBS. As the patient had a positive cytomegalovirus (CMV) antigenemia, this was the aetiology suspected for his neurologic findings, but specific treatment failed to improve his clinical situation, and he died on day +123. Necropsy demonstrated cerebral toxoplasmosis and axonal degeneration of nerve roots compatible with the axonal form of GBS. Interestingly, the polymerase chain reaction (PCR) signal for Toxoplasma gondii in two different cerebrospinal fluid (CSF) samples had been negative. In addition, this case showed unique magnetic resonance imaging (MRI) abnormalities. We conclude that a negative PCR on CSF cannot exclude toxoplasmosis in a transplant patient, and we emphasise the importance of considering Toxoplasma as an aetiology of fever and neurological symptoms in the transplant setting.
我们报告了一例不同寻常的病例，一名25岁诊断为慢性粒细胞白血病（CML）的患者，在接受了不匹配的异基因外周干细胞移植（PSCT）后，发生了与吉兰 - 巴雷综合征（GBS）相关的脑弓形虫病。在移植后第83天，他开始发烧，7天后出现震颤、肌肉无力、复视、构音障碍、呼吸困难和全身反射消失，符合GBS表现。由于患者巨细胞病毒（CMV）抗原血症呈阳性，这被怀疑是其神经学表现的病因，但特异性治疗未能改善其临床状况，患者于移植后第123天死亡。尸检显示脑弓形虫病以及与轴索性GBS相符的神经根轴索变性。有趣的是，两份不同脑脊液（CSF）样本中弓形虫的聚合酶链反应（PCR）信号均为阴性。此外，该病例显示出独特的磁共振成像（MRI）异常。我们得出结论，脑脊液PCR阴性不能排除移植患者的弓形虫病，并且我们强调在移植环境中考虑弓形虫作为发热和神经症状病因的重要性。
