Sj. Arnold et al., DISSEMINATED TOXOPLASMOSIS - UNUSUAL PRESENTATIONS IN THE IMMUNOCOMPROMISED HOST, Archives of pathology and laboratory medicine, 121(8), 1997, pp. 869-873
Citations number
16
Categorie Soggetti
Pathology,"Medical Laboratory Technology","Medicine, Research & Experimental
Objective.--Owing to the increasing number of patients with acquired i
mmunodeficiency syndrome and immuno-suppressed transplant patients, di
sseminated Toxoplasma gondii has emerged as a potentially fatal pathog
en. Common presentations include encephalitis, pneumonia, and myocardi
tis. The objective of this report is to describe the clinical course,
histologic features, and outcome in two immunocompromised patients wit
h disseminated toxoplasmosis presenting with parasitemia and panniculi
tis. Materials and Methods.--Two cases of disseminated toxoplasmosis p
resenting with parasitemia (patient 1) and panniculitis (patient 2) we
re retrieved from the clinical, surgical, and autopsy pathology archiv
es of Vanderbilt University Medical Center, Nashville, Tenn. The histo
logy and diagnostic approaches used are reported. Charts were reviewed
for primary diagnosis, therapy protocols, clinical presentation of in
fection, and outcome. Results.--Patient 1 developed a clinically unexp
lained sepsis syndrome shortly after heart transplantation; T gondii p
arasitemia was diagnosed by examination of peripheral blood smears. Th
e diagnosis was confirmed at autopsy. Patient 2 was a child undergoing
induction chemotherapy for lymphoma who developed rapidly progressive
neurologic deterioration accompanied by a maculopapular skin rash; T
gondii panniculitis was diagnosed retrospectively when histologic exam
ination was combined with immunohistochemistry. Autopsies performed in
both cases confirmed widely disseminated infection. Conclusions.--Dis
seminated toxoplasmosis should be considered in the differential diagn
osis of immunocompromised patients with culture-negative sepsis syndro
me, particularly if combined with neurologic, respiratory, or unexplai
ned skin lesions. Examination of Wright's-stained peripheral blood sme
ars or antitoxoplasma immunoperoxidase studies of skin biopsies may be
diagnostic and allow rapid initiation of antibiotic therapy. Autopsy
findings contributed to both of our cases by documenting the widesprea
d heavy parasite burden and demonstrating numerous diagnostic T gondii
cyst forms.