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Asymptomatic diffuse "encephalitic" cerebral toxoplasmosis in a woman with systemic lupus erythematosus.

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.

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  • 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.

    Source

    MeSH

    Adult
    Autopsy
    Encephalitis
    Fatal Outcome
    Female
    Humans
    Immunocompromised Host
    Kidney Transplantation
    Lupus Nephritis
    Opportunistic Infections
    Toxoplasmosis, Cerebral

    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 -