Abedalthagafi Malak, Rushing Elisabeth J, Garvin David, Cheson Bruce, Ozdemirli Metin
Department of Pathology, Georgetown University Hospital, Washington, DC 20007, USA.
Int J Clin Exp Pathol. 2009 Mar 15;3(1):106-9.
Opportunistic infections account for the majority of central nervous system lesions in adult immunosuppressed patients. In this setting, toxoplasmosis typically manifests as multiple abscesses readily seen on routine neuroimaging studies. Asymptomatic, widely disseminated Toxoplasma cysts without parenchymal reaction are also recognized. In contrast, widespread parasites in the brain parenchyma with an inflammatory "encephalitic" reaction and little or no necrosis have been reported in only four patients with acquired immune deficiency syndrome (AIDS). We describe a 70 year old male with stage IV chronic lymphocytic leukemia complicated by aplastic anemia. Neurological examination and imaging revealed no significant abnormalities. At autopsy, the brain revealed multifocal cysts and free tachyzoites of Toxoplasma gondii with diffuse microglial nodules and no necrosis. To the best of our knowledge, this case represents the first report of the "encephalitic" form of toxoplasmosis in a non-AIDS patient.
机会性感染是成年免疫抑制患者中枢神经系统病变的主要原因。在这种情况下，弓形虫病通常表现为在常规神经影像学检查中容易看到的多个脓肿。无症状、广泛播散且无实质反应的弓形虫囊肿也已被确认。相比之下，仅有4例获得性免疫缺陷综合征（AIDS）患者报告了脑实质内广泛存在寄生虫并伴有炎症性“脑炎”反应且几乎没有坏死的情况。我们描述了一名患有IV期慢性淋巴细胞白血病并伴有再生障碍性贫血的70岁男性。神经学检查和影像学检查均未发现明显异常。尸检时，大脑发现了多灶性囊肿和刚地弓形虫的游离速殖子，伴有弥漫性小胶质结节且无坏死。据我们所知，该病例是首例非AIDS患者出现“脑炎”型弓形虫病的报告。
