1887

Abstract

Introduction:

is a parasite estimated to infect one-third of the global population, surviving in tissues in a latent form. Although cerebral toxoplasmosis is predominantly recognized as an opportunistic infection in hosts immunocompromised secondary to human immunodeficiency virus or bone marrow transplant, there is increasing recognition that this infection can occur in patients receiving immunomodulating agents such as mAb therapy targeted against T-cells, B-cells and TNF. The indications for these therapies are expanding, resulting in a larger at-risk population for this rare but serious and potentially avoidable complication.

Case Presentation:

This is one of the few case reports of cerebral toxoplasmosis following rituximab-based chemotherapy in a patient with a haematological malignancy. We describe a patient presenting with focal neurological deficits and radiographic evidence of multi-focal cerebral ring-enhancing lesions following completion of rituximab therapy for splenic marginal zone lymphoma. Brain biopsy confirmed a diagnosis of cerebral toxoplasmosis. Antibiotic treatment with trimethoprim/sulfamethoxazole resulted in near-complete radiological and clinical resolution of the neurological deficits, and a return to baseline functional status.

Conclusion:

Reactivation of toxoplasmosis resulting in intracerebral disease is a potential severe and preventable complication of rituximab therapy. Further studies are required to assess the need both for screening and prescribing primary chemoprophylaxis for toxoplasmosis when initiating rituximab therapy.

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2015-12-13
2019-10-18
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