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Asymptomatic diffuse "encephalitic" cerebral toxoplasmosis in a woman with systemic lupus erythematosus.
J Clin Neurosci 2016; 29:194-6JC

Abstract

Classic cerebral toxoplasmosis typically presents with neurologic symptoms such as seizures and mental status changes and histological examination shows focal lesions with necrosis. However, in the diffuse "encephalitic" form, patients are asymptomatic with diffuse, inflammatory, non-necrotic lesions. Asymptomatic diffuse "encephalitic" toxoplasmosis has been reported only in four acquired immunodeficiency syndrome patients and one human immunodeficiency virus (HIV) negative patient with chronic lymphocytic leukemia. We present a 36-year-old HIV-negative woman with systemic lupus erythematosus and lupus nephritis who was on immunosuppression for 9years after cadaveric renal transplant and died from pulmonary hemorrhage and cytomegalovirus pneumonia. Brain autopsy findings revealed multifocal microglial nodules containing Toxoplasma bradyzoites and associated astrogliosis. These nodules were prominent in the cerebellum, midbrain and medulla and also present in the cortex and thalamus. No coagulative necrosis, necrotizing abscesses, or other opportunistic infections were present. The patient had previously exhibited no neurologic symptoms and there was no clinical suspicion for toxoplasmosis. To the best of our knowledge, this is the first case of diffuse, non-necrotizing, "encephalitic" cerebral toxoplasmosis reported in a lupus patient and also the first reported female case.

Authors+Show Affiliations

Rush University Medical Center, 1750 W Harrison Street, Ste 570 Jelke, Chicago, IL 60661, USA. Electronic address: diana_murro@rush.edu.Rush University Medical Center, 1750 W Harrison Street, Ste 570 Jelke, Chicago, IL 60661, USA.Rush University Medical Center, 1750 W Harrison Street, Ste 570 Jelke, Chicago, IL 60661, USA.

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

26896909

Citation

Murro, Diana, et al. "Asymptomatic Diffuse "encephalitic" Cerebral Toxoplasmosis in a Woman With Systemic Lupus Erythematosus." Journal of Clinical Neuroscience : Official Journal of the Neurosurgical Society of Australasia, vol. 29, 2016, pp. 194-6.
Murro D, Novo J, Arvanitis L. Asymptomatic diffuse "encephalitic" cerebral toxoplasmosis in a woman with systemic lupus erythematosus. J Clin Neurosci. 2016;29:194-6.
Murro, D., Novo, J., & Arvanitis, L. (2016). Asymptomatic diffuse "encephalitic" cerebral toxoplasmosis in a woman with systemic lupus erythematosus. Journal of Clinical Neuroscience : Official Journal of the Neurosurgical Society of Australasia, 29, pp. 194-6. doi:10.1016/j.jocn.2015.12.022.
Murro D, Novo J, Arvanitis L. Asymptomatic Diffuse "encephalitic" Cerebral Toxoplasmosis in a Woman With Systemic Lupus Erythematosus. J Clin Neurosci. 2016;29:194-6. PubMed PMID: 26896909.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Asymptomatic diffuse "encephalitic" cerebral toxoplasmosis in a woman with systemic lupus erythematosus. AU - Murro,Diana, AU - Novo,Jorge, AU - Arvanitis,Leonidas, Y1 - 2016/02/17/ PY - 2015/12/07/received PY - 2015/12/29/accepted PY - 2016/2/22/entrez PY - 2016/2/22/pubmed PY - 2017/3/16/medline KW - Central nervous system KW - Renal transplant KW - Systemic lupus erythematosus KW - Toxoplasma KW - Toxoplasmosis SP - 194 EP - 6 JF - Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia JO - J Clin Neurosci VL - 29 N2 - Classic cerebral toxoplasmosis typically presents with neurologic symptoms such as seizures and mental status changes and histological examination shows focal lesions with necrosis. However, in the diffuse "encephalitic" form, patients are asymptomatic with diffuse, inflammatory, non-necrotic lesions. Asymptomatic diffuse "encephalitic" toxoplasmosis has been reported only in four acquired immunodeficiency syndrome patients and one human immunodeficiency virus (HIV) negative patient with chronic lymphocytic leukemia. We present a 36-year-old HIV-negative woman with systemic lupus erythematosus and lupus nephritis who was on immunosuppression for 9years after cadaveric renal transplant and died from pulmonary hemorrhage and cytomegalovirus pneumonia. Brain autopsy findings revealed multifocal microglial nodules containing Toxoplasma bradyzoites and associated astrogliosis. These nodules were prominent in the cerebellum, midbrain and medulla and also present in the cortex and thalamus. No coagulative necrosis, necrotizing abscesses, or other opportunistic infections were present. The patient had previously exhibited no neurologic symptoms and there was no clinical suspicion for toxoplasmosis. To the best of our knowledge, this is the first case of diffuse, non-necrotizing, "encephalitic" cerebral toxoplasmosis reported in a lupus patient and also the first reported female case. SN - 1532-2653 UR - https://www.unboundmedicine.com/medline/citation/26896909/Asymptomatic_diffuse_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0967-5868(16)00019-9 DB - PRIME DP - Unbound Medicine ER -