Acute exacerbation of pulmonary toxoplasmosis during corticosteroid therapy for immune thrombocytopenia: A case report and literature review. Issue 51 (23rd December 2021)

• Record Type: Journal Article
• Authors: Omori, Koji; Imoto, Naoto; Norose, Kazumi; Maeda, Matsuyoshi; Hikosaka, Kenji; Kurahashi, Shingo
• Other Names: Saranathan. Maya section editor.
• Is Part Of: Medicine. Volume 100:Issue 51(2021)
• Publication Date: 2021-12-23
• Subjects: acute respiratory distress syndrome -- immune thrombocytopenia -- pulmonary toxoplasmosis -- trimethoprim–sulfamethoxazole prophylaxis; Medicine -- Periodicals; Medicine -- Periodicals; Médecine -- Périodiques; Geneeskunde; Medicine; Periodicals; Periodicals; 610.5
• DOI: 10.1097/MD.0000000000028430
• Languages: English
• ISSNs: 0025-7974

Abstract

Abstract: Rationale: Pulmonary toxoplasmosis (PT) is an infectious disease that can be fatal if reactivation occurs in the recipients of hematopoietic stem cell transplantation (HSCT) who were previously infected with Toxoplasma gondii . However, whether the toxoplasmosis reactivation is an actual risk factor for patients receiving immunosuppressive therapies without HSCT remains unclear. Therefore, reactivated PT is not typically considered as a differential diagnosis for pneumonia other than in patients with HSCT or human immunodeficiency virus (HIV). Patient concerns: A 77-year-old man presented with fever and nonproductive cough for several days. He was hospitalized due to atypical pneumonia that worsened immediately despite antibiotic therapy. Before 4 months, he was diagnosed with immune thrombocytopenia (ITP) and received corticosteroid therapy. Trimethoprim–sulfamethoxazole (ST) was administered to prevent pneumocystis pneumonia resulting from corticosteroid therapy. Diagnosis: The serological and culture test results were negative for all pathogens except T. gondii immunoglobulin G antibody. Polymerase chain reaction, which can detect T. gondii from frozen bronchoalveolar lavage fluid, showed positive results. Therefore, he was diagnosed with PT. Intervention: ST, clindamycin, and azithromycin were administered. Pyrimethamine and sulfadiazine could not be administered because his general condition significantly worsened at the time of polymerase chain reaction (PCR) examination. Outcomes: The patient died of acute respiratory distress syndrome despite anti- T. gondii treatment. An autopsy revealed a severe organizing pneumonia and a small area of bronchopneumonia. Lessons: PT should be considered as a differential diagnosis in patients with pneumonia, particularly in seropositive patients who receive immunosuppressive therapies even for other than HSCT or HIV.