DIAGNOSIS OF PULMONARY TOXOPLASMOSIS BY BRONCHOALVEOLAR LAVAGE IN CARDIAC TRANSPLANT RECIPIENTS

We report two cases of fatal, clinically unsuspected disseminated toxo plasmosis that developed following orthotopic cardiac transplantation. Toxoplasma gondii trophozoites, pseudocysts, and cysts were best visu alized on hematoxylin and eosin and Giemsa-stained cytospin preparatio ns of bronchoalveolar lavage fluid. Post-mortem examination in both ca ses revealed disseminated toxoplasmosis with extensive involvement of the lungs and heart. The patients, who were seronegative for antibody to T. gondii prior to transplantation, received organs from donors who se serology status was unknown. Demonstration of anti-toxoplasma antib odies post-transplantation occurred in both cases. Bronchoalveolar lav age may be useful in diagnosis of pulmonary toxoplasmosis. Clinicians, pathologists, and cytopathologists must consider T. gondii in the dif ferential diagnosis of pneumonia in the immunocompromised patient, esp ecially cardiac transplant patients. (C) 1993 Wiley-Liss, Inc.