Hill Brittany, Wyatt Nicole, Ennis David
Internal Medicine, Brookwood Baptist Medical Center, Birmingham, USA.
Infectious Disease, University of Alabama at Birmingham, Birmingham, USA.
Cureus. 2020 Jun 10;12(6):e8547. doi: 10.7759/cureus.8547.
Cerebral toxoplasmosis is a life-threatening infection most commonly found in immunocompromised hosts such as acquired immunodeficiency syndrome (AIDS) or transplant patients. However, it is not known to affect patients with chronic inflammatory disorders on immunosuppressive therapy. We describe the case of a 70-year-old female with rheumatoid arthritis (RA) on chronic therapy with methotrexate and infliximab, who presented to the hospital after two weeks of right-sided weakness. Imaging revealed bilateral ring-enhancing lesions in the basal ganglia (left greater than right). A diagnosis of cerebral toxoplasmosis was made on brain biopsy. Apart from the immunosuppressive therapy and owning a cat, she had no other risk factors for developing the infection. The patient's immunosuppressive medications were discontinued, and she was started on high-dose trimethoprim-sulfamethoxazole (TMP-SMX). Upon literature review using PubMed, we found seven other published reports on similar cases of toxoplasmosis in RA patients on immunosuppressive therapy; however, there was a lack of recommendations for diagnosis, treatment, and prophylaxis in this patient population. With the growing use of immunosuppressive therapies in chronic inflammatory disorders, further data is needed regarding the management of toxoplasmosis in these patients. This case report is an investigation of the relationship between immunosuppressive medications in RA patients and cerebral toxoplasmosis and an exploration of the available recommendations for its management.
脑弓形虫病是一种危及生命的感染，最常见于免疫功能低下的宿主，如获得性免疫缺陷综合征（AIDS）患者或移植患者。然而，目前尚不清楚它是否会影响接受免疫抑制治疗的慢性炎症性疾病患者。我们报告一例70岁女性类风湿关节炎（RA）患者，该患者长期接受甲氨蝶呤和英夫利昔单抗治疗，在出现右侧肢体无力两周后入院。影像学检查显示基底节区双侧环形强化病灶（左侧大于右侧）。经脑活检确诊为脑弓形虫病。除了免疫抑制治疗和养猫外，她没有其他感染风险因素。停用患者的免疫抑制药物，并开始使用高剂量的甲氧苄啶-磺胺甲恶唑（TMP-SMX）。通过使用PubMed进行文献检索，我们发现了另外七篇关于接受免疫抑制治疗的RA患者发生类似弓形虫病病例的报道；然而，对于该患者群体的诊断、治疗和预防缺乏相关建议。随着免疫抑制疗法在慢性炎症性疾病中的使用日益增加，需要更多关于这些患者弓形虫病管理的数据。本病例报告旨在研究RA患者免疫抑制药物与脑弓形虫病之间的关系，并探索其管理的现有建议。
