Parasram Melvin, Arevalo-Perez Julio
Department of Neurology, Weill Cornell Medicine.
Department of Radiology, Memorial Sloan Kettering Cancer Center, New York City, New York, United States.
Surg Neurol Int. 2022 May 6;13:191. doi: 10.25259/SNI_271_2022. eCollection 2022.
Cerebral toxoplasmosis is a rare complication of relapsed/refractory multiple myeloma (MM) after autologous stem cell transplant (SCT). Imaging characteristics can be helpful in leading to rapid diagnosis and treatment.
A 76-year-old man with relapsed/refractory IgA kappa MM status post autologous SCT who presented to the hospital with altered mental status. His hospital course was complicated by rapid decompensation to obtundation requiring intubation. Magnetic resonance imaging (MRI) of the brain revealed numerous ring-enhancing lesions with eccentric target signs, which were concerning for cerebral toxoplasmosis. Diagnosis was confirmed with positive toxoplasma cerebrospinal fluid polymerase chain reaction test.
Cerebral toxoplasmosis should be considered in the differential diagnosis for MM patients who present with altered mental status and neurologic findings. The ring-enhancing lesion with eccentric target sign on MRI can be helpful in the diagnosis of cerebral toxoplasmosis.
脑弓形虫病是自体干细胞移植（SCT）后复发/难治性多发性骨髓瘤（MM）的一种罕见并发症。影像学特征有助于快速诊断和治疗。
一名76岁男性，自体SCT后复发/难治性IgA κ型MM，因精神状态改变入院。他的住院过程因迅速失代偿至昏迷而需要插管而复杂化。脑部磁共振成像（MRI）显示大量环形强化病变，伴有偏心靶征，高度怀疑为脑弓形虫病。脑脊液弓形虫聚合酶链反应检测呈阳性，确诊该病。
对于出现精神状态改变和神经系统表现的MM患者，鉴别诊断时应考虑脑弓形虫病。MRI上具有偏心靶征的环形强化病变有助于脑弓形虫病的诊断。
