REACTIVATION TOXOPLASMIC RETINOCHOROIDITIS IN PATIENTS UNDERGOING BONE-MARROW TRANSPLANTATION - IS THERE A ROLE FOR CHEMOPROPHYLAXIS

The objective of this study was to report the occurrence of reactivati on ocular toxoplasmosis in bone marrow transplant (BMT) recipients and to propose guidelines for identification and chemoprophylaxis of high -risk patients. The study design was a series of cases from the tertia ry care university hospital which has an active BMT program. The patie nts were two recipients of autologous BMTs with past histories of toxo plasma retinochoroiditis who developed symptomatic reactivation of ocu lar toxoplasmosis as documented by formal ophthalmologic examination i n the early post-transplant period. Ophthalmoscopic examinations in th e two patients with non-Hodgkin's lymphoma who received autologous tra nsplants and then developed decreased visual acuity in the first week after transplant revealed recurrent retinochoroiditis adjacent to old toxoplasma lesions. Pre-transplant eye examinations in both patients h ad demonstrated only inactive chorioretinal scars. Therapy with sulfad iazine, pyrimethamine and prednisone ultimately led to resolution of r etinitis in both patients. BMT recipients who are seropositive for ant ibody to T. gondii and have findings consistent with previous toxoplas ma retinochoroiditis on pre-transplant ophthalmologic examination appe ar to be at risk for reactivation of ocular toxoplasmosis in the early post-transplant period and may warrant preventive chemoprophylaxis fo r toxoplasmosis.