Asymptomatic diffuse "encephalitic" cerebral toxoplasmosis in a patient with chronic lymphocytic leukemia: case report and review of the literature

Opportunistic infections account for the majority of central nervous system lesions in adult immunosuppressed patients. In this setting, toxoplasmosis typically manifests as multiple abscesses readily seen on routine neuroimaging studies. Asymptomatic, widely disseminated Toxoplasma cysts without pa...

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Bibliographic Details
Published in:International journal of clinical and experimental pathology 2010-01, Vol.3 (1), p.106-109
Main Authors: Abedalthagafi, Malak, Rushing, Elisabeth J, Garvin, David, Cheson, Bruce, Ozdemirli, Metin
Format: Article
Language:English
Subjects:
Aged
Anemia, Aplastic - complications
Anemia, Aplastic - pathology
Brain - parasitology
Brain - pathology
Case Report
Humans
Immunocompromised Host
Leukemia, Lymphocytic, Chronic, B-Cell - immunology
Leukemia, Lymphocytic, Chronic, B-Cell - pathology
Male
Opportunistic Infections - immunology
Opportunistic Infections - pathology
Toxoplasma - isolation & purification
Toxoplasma - physiology
Toxoplasmosis, Cerebral - immunology
Toxoplasmosis, Cerebral - pathology
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Summary:Opportunistic infections account for the majority of central nervous system lesions in adult immunosuppressed patients. In this setting, toxoplasmosis typically manifests as multiple abscesses readily seen on routine neuroimaging studies. Asymptomatic, widely disseminated Toxoplasma cysts without parenchymal reaction are also recognized. In contrast, widespread parasites in the brain parenchyma with an inflammatory "encephalitic" reaction and little or no necrosis have been reported in only four patients with acquired immune deficiency syndrome (AIDS). We describe a 70 year old male with stage IV chronic lymphocytic leukemia complicated by aplastic anemia. Neurological examination and imaging revealed no significant abnormalities. At autopsy, the brain revealed multifocal cysts and free tachyzoites of Toxoplasma gondii with diffuse microglial nodules and no necrosis. To the best of our knowledge, this case represents the first report of the "encephalitic" form of toxoplasmosis in a non-AIDS patient.
ISSN:1936-2625