Division of Psychiatry, Department of Supportive Care Medicine, City of Hope, Duarte, CA, USA.
City of Hope Observership Program, City of Hope, Duarte, CA, USA.
Palliat Support Care. 2024 Jun;22(3):623-625. doi: 10.1017/S1478951524000105.
Due to their immunocompromised state, recipients of hematopoietic stem cell transplants (HSCTs) are at a higher risk of opportunistic infections, such as that of toxoplasmosis. Toxoplasmosis is a rare but mortal infection that can cause severe neurological symptoms, including confusion. In immunosuppressed individuals, such as those with acquired immunodeficiency syndrome (AIDS), toxoplasmosis can cause movement disorders, including hemichorea-hemiballismus. We present the case of a 54-year-old Caucasian male with a history of hypertension and JAK-2-negative primary myelofibrosis who underwent an allogeneic peripheral blood stem cell transplant from a related donor. After the development of acute changes in mental status, left-sided weakness, and left-sided hemichorea-hemiballismus post-transplant, the patient was readmitted to the hospital. Subsequent testing included an magnetic resonance imaging (MRI) of the brain, which revealed multiple ring-enhancing lesions around the thalami and basal ganglia, as well as a cerebrospinal fluid tap that tested positive for toxoplasmosis. The patient was initially treated with intravenous clindamycin and oral pyrimethamine with leucovorin. The completion of treatment improved the patient's mental status but did not improve his hemichorea-hemiballismus. This case illustrates an uncommon complication associated with central nervous system (CNS) toxoplasmosis in stem cell transplant recipients. Due to its rarity, cerebral toxoplasmosis in immunocompromised patients often remains undetected, particularly in HSCT patients who are immunosuppressed to improve engraftment. Neurological and neuropsychiatric symptoms due to toxoplasmosis may be misidentified as psychiatric morbidities, delaying appropriate treatment. Polymerase chain reaction (PCR) assays offer methods that are sensitive and specific to detecting toxoplasmosis and provide opportunities for early intervention.
由于免疫功能低下，造血干细胞移植（HSCT）受者有更高的机会发生机会性感染，如弓形体病。弓形体病是一种罕见但致命的感染，可导致严重的神经系统症状，包括意识模糊。在免疫抑制个体中，如获得性免疫缺陷综合征（AIDS）患者，弓形体病可引起运动障碍，包括偏侧舞蹈-投掷症。我们报告了一例 54 岁白人男性，有高血压和 JAK2 阴性原发性骨髓纤维化病史，他接受了来自相关供体的异基因外周血造血干细胞移植。移植后出现精神状态急性改变、左侧无力和左侧偏侧舞蹈-投掷症后，患者再次入院。随后的检查包括脑磁共振成像（MRI），显示丘脑和基底节周围有多个环形增强病变，以及脑脊液穿刺检查弓形体病阳性。患者最初接受静脉注射克林霉素和口服氨苯砜联合亚叶酸钙治疗。完成治疗后改善了患者的精神状态，但未改善其偏侧舞蹈-投掷症。该病例说明了与干细胞移植受者中枢神经系统（CNS）弓形体病相关的一种不常见并发症。由于其罕见性，免疫抑制患者的脑弓形体病常未被发现，特别是在为改善植入而进行免疫抑制的 HSCT 患者中。由于弓形体病引起的神经和神经精神症状可能被误认为是精神疾病，从而延迟了适当的治疗。聚合酶链反应（PCR）检测提供了敏感和特异的方法来检测弓形体病，并为早期干预提供了机会。
