Methylprednisolone
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Toxoplasmosis reactivation in an immunocompromised patient: case report A 40-year-old man’s Toxoplasma gondii infection was reactivated following immunosuppressive therapy with methylprednisolone. The man received a stem cell transplant for refractory chronic lymphocytic leukaemia; engraftment was confirmed on post-transplant day 25. Before the transplant, serology revealed that he was a Toxoplasma-seropositive recipient, and despite having a seronegative donor, was at risk of toxoplasmosis reactivation. On post-transplant day 112, he developed grade III-IV cutaneous graft-versushost-disease (GVHD) which required intense immunosuppression with methylprednisolone [dosage, route and duration of treatment not stated] and antiinterleukin-2 receptor antibodies. On day 142, he developed haemolytic uraemic syndrome; despite aggressive supportive treatment, his condition rapidly worsened. He developed acute respiratory failure with severe hypoxaemia on day 145. CT scan revealed pulmonary infiltrates and nodules in both lungs. On day 148, bronchoalveolar lavage samples stained positive for T. gondii tachyzoites. The man received pyrimethamine/clindamycin but died on day 150. Postmortem serum analysis confirmed toxoplasmosis reactivation. Author comment: "In immunocompromised patients, toxoplasmosis is a life-threatening opportunistic infection, resulting mainly from reactivation. . . Developing GVHD is also a risk factor, probably due to deep and long-lasting immunosuppressive therapy . . ." Delhaes L, et al. Severe pulmonary toxoplasmosis after allo-SCT in two patients: From Toxoplasma genotyping to clinical management. Bone Marrow Transplantation 45: 580-583, No. 3, Mar 2010. Available from: URL: http:// 803015248 dx.doi.org/10.1038/bmt.2009.167 - France
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Editorial comment: This article reported two cases of post-transplant toxoplasmosis, but only one was associated with immunosuppressive therapy.
0114-9954/10/1302-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved
Reactions 22 May 2010 No. 1302
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