Brain Toxoplasmosis and Bacterial Infection after Liver Transplantation

• Published in: Canadian journal of neurological sciences 2023-01, Vol.50 (1), p.155-157
• Main Authors: Graham, Alice K., Sharma, Sunjay, Yamamura, Deborah, Kameda-Smith, Michelle M., Main, Cheryl, Lu, Jian-Qiang
• Format: Article
• Language: English
• Subjects: Abdomen; Abscesses; Asymptomatic; Bacterial Infections; Brain; Brain cancer; Comorbidity; Diabetes; Edema; Humans; Immunocompromised Host; Infections; Letter to the Editor: New Observation; Liver; Liver Transplantation; Liver transplants; Magnetic resonance imaging; Pathology; Patients; Toxoplasmosis; Transplants & implants
• ISSN: 0317-1671; 2057-0155
• DOI: 10.1017/cjn.2021.494

Toxoplasma gondii (TG) affects one-third of the global human population and commonly involves the central nervous system (CNS)/brain more frequently in immunocompromised patients.1 Subclinical or asymptomatic cerebral toxoplasmosis is relatively common in immunocompetent individuals and occasionally seen in immunocompromised patients. The immunocompromised status can result from immunosuppressant and/or immunomodulatory treatment in patients after organ transplantation, and other immunosuppressive conditions such as human immunodeficiency virus infection.1–5 Focal CNS infectious lesions or brain abscesses are known complications of transplantation, and have been documented in 0.36–1% of organ transplant recipients.2 CNS toxoplasmosis occurs variably in transplant recipients with the highest incidence (13–53%) in cardiac transplantation and the lowest incidence in liver transplantation (rarely reported). Subsequent brain magnetic resonance imaging (MRI) disclosed multiple T2/FLAIR hyperintense, and T1 post-contrast nodular or ring enhancing lesions in the brain parenchyma including the left frontal region (largest, 22.5 × 10.1 mm, with brain edema and mass effect causing a left-to-right midline shift), as well as left temporal, right frontal, and parietal regions (Figure 1). A systematic review of TG infection after liver transplantation revealed that IgM anti-Toxoplasma antibodies were found in 30% of the recipients, and Toxoplasma DNA or tachyzoites were reported in 67% of the seronegative recipients,10 while the pretransplant TG serology was usually negative.5 TG infection may be reactivated in the recipients due to their immunosuppressive treatment or other events that further suppress the immune system.