Cancelas J A, López-Jiménez J, González C, Calbo M A, García Laraña J
Servicio de Hematología, Hospital Ramón y Cajal, Madrid.
Med Clin (Barc). 1994 Oct 1;103(10):383-4.
The diagnosis of cerebral toxoplasmosis in an immunosuppressed patient is based on computer tomography (CT) findings and response to specific empiric treatment. Although infrequent, cerebral toxoplasmosis has been described in patients undergoing bone marrow transplantation (BMT) with lesions compatible with this diagnosis always being found on cranial CT. The case of a patient with Burkitt's lymphoma who received BMT and developed convulsive crisis with repeatedly normal cranial CT scans during the course of severe immunosuppression (graft versus host disease and treatment with 3 immunosuppressive drugs) is presented. Post mortem study demonstrated cerebral cysts of Toxoplasma gondii with slight perilesional inflammatory infiltrate. Normal CT in patients with neurologic foci and severe immunosuppression following BMT does not exclude the diagnosis of cerebral toxoplasmosis, therefore more sensitive diagnostic techniques should be performed, particularly in areas in which infection by toxoplasma is endemic.
免疫抑制患者脑弓形虫病的诊断基于计算机断层扫描（CT）结果以及对特定经验性治疗的反应。虽然不常见，但脑弓形虫病已在接受骨髓移植（BMT）的患者中被描述，在头颅CT上总能发现与该诊断相符的病变。本文介绍了一例患有伯基特淋巴瘤的患者，该患者接受了BMT，并在严重免疫抑制（移植物抗宿主病和使用3种免疫抑制药物治疗）过程中出现惊厥发作，而头颅CT扫描多次显示正常。尸检研究显示有弓形虫脑囊肿，伴有轻微的病灶周围炎性浸润。BMT后出现神经病灶且严重免疫抑制的患者CT正常并不排除脑弓形虫病的诊断，因此应采用更敏感的诊断技术，特别是在弓形虫感染为地方病的地区。
