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Disseminated toxoplasmosis with atypical symptoms which developed with exacerbation of systemic lupus erythematosus.

Abstract

Toxoplasma is a common parasite worldwide that mainly affects the brain, lungs and eyes. Although toxoplasmic encephalitis is a lethal disease without treatment, past case reports show most patients with systemic lupus erythematosus who developed toxoplasmic encephalitis were misdiagnosed and treated as neuropsychiatric systemic lupus erythematosus, which led to unfavorable outcomes. We herein describe a case of disseminated toxoplasmosis affecting all the above organs with atypical symptoms, which developed with exacerbation of systemic lupus erythematosus. She had initially manifested with retinochoroiditis without vitritis, mild cognitive impairment and an isolated lung mass. These are completely different from the classic symptoms of toxoplasmosis that have been reported in patients with HIV infection and/or those after hematopoietic transplantation. Our case, together with previously reported cases, suggests the manifestation of toxoplasmosis that develops in systemic lupus erythematosus patients can be different from that seen in conventional cases and varies between individual patients. Our case highlights both the difficulty in and the importance of diagnosing toxoplasmosis in patients with systemic lupus erythematosus and provides helpful information to identify this rare, devastating, yet treatable disease.

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  • Authors+Show Affiliations

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    1 Department of Allergy and Clinical Immunology, Chiba University Hospital, Chiba, Japan.

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    1 Department of Allergy and Clinical Immunology, Chiba University Hospital, Chiba, Japan.

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    1 Department of Allergy and Clinical Immunology, Chiba University Hospital, Chiba, Japan.

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    1 Department of Allergy and Clinical Immunology, Chiba University Hospital, Chiba, Japan.

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    1 Department of Allergy and Clinical Immunology, Chiba University Hospital, Chiba, Japan.

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    1 Department of Allergy and Clinical Immunology, Chiba University Hospital, Chiba, Japan.

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    1 Department of Allergy and Clinical Immunology, Chiba University Hospital, Chiba, Japan.

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    2 Department of Ophthalmology and Visual Science, Chiba University, Graduate School of Medicine, Japan.

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    3 Department of Allergy and Rheumatology, Japanese Red Cross Narita Hospital, Chiba, Japan.

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    4 Department of Infectious Diseases, Japanese Red Cross Narita Hospital, Chiba, Japan.

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    5 Department of Infection and Host Defense, Chiba University, Chiba, Japan.

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    5 Department of Infection and Host Defense, Chiba University, Chiba, Japan.

    1 Department of Allergy and Clinical Immunology, Chiba University Hospital, Chiba, Japan.

    Source

    Lupus 28:1 2019 Jan pg 133-136

    MeSH

    Adult
    Brain
    Diagnosis, Differential
    Female
    Humans
    Lung
    Lupus Erythematosus, Systemic
    Lupus Vasculitis, Central Nervous System
    Magnetic Resonance Imaging
    Ophthalmoscopes
    Opportunistic Infections
    Tomography, X-Ray Computed
    Toxoplasmosis, Cerebral

    Pub Type(s)

    Case Reports
    Journal Article

    Language

    eng

    PubMed ID

    30486727

    Citation

    Furuya, H, et al. "Disseminated Toxoplasmosis With Atypical Symptoms Which Developed With Exacerbation of Systemic Lupus Erythematosus." Lupus, vol. 28, no. 1, 2019, pp. 133-136.
    Furuya H, Ikeda K, Iida K, et al. Disseminated toxoplasmosis with atypical symptoms which developed with exacerbation of systemic lupus erythematosus. Lupus. 2019;28(1):133-136.
    Furuya, H., Ikeda, K., Iida, K., Suzuki, K., Furuta, S., Tamachi, T., ... Nakajima, H. (2019). Disseminated toxoplasmosis with atypical symptoms which developed with exacerbation of systemic lupus erythematosus. Lupus, 28(1), pp. 133-136. doi:10.1177/0961203318815583.
    Furuya H, et al. Disseminated Toxoplasmosis With Atypical Symptoms Which Developed With Exacerbation of Systemic Lupus Erythematosus. Lupus. 2019;28(1):133-136. PubMed PMID: 30486727.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Disseminated toxoplasmosis with atypical symptoms which developed with exacerbation of systemic lupus erythematosus. AU - Furuya,H, AU - Ikeda,K, AU - Iida,K, AU - Suzuki,K, AU - Furuta,S, AU - Tamachi,T, AU - Suzuki,K, AU - Miura,G, AU - Hiraguri,M, AU - Hase,R, AU - Hikosaka,K, AU - Norose,K, AU - Nakajima,H, Y1 - 2018/11/28/ PY - 2018/11/30/pubmed PY - 2019/1/15/medline PY - 2018/11/30/entrez KW - Systemic lupus erythematosus KW - cerebral toxoplasmosis KW - disseminated toxoplasmosis KW - neuropsychiatric systemic lupus erythematosus KW - ocular toxoplasmosis KW - pulmonary toxoplasmosis SP - 133 EP - 136 JF - Lupus JO - Lupus VL - 28 IS - 1 N2 - Toxoplasma is a common parasite worldwide that mainly affects the brain, lungs and eyes. Although toxoplasmic encephalitis is a lethal disease without treatment, past case reports show most patients with systemic lupus erythematosus who developed toxoplasmic encephalitis were misdiagnosed and treated as neuropsychiatric systemic lupus erythematosus, which led to unfavorable outcomes. We herein describe a case of disseminated toxoplasmosis affecting all the above organs with atypical symptoms, which developed with exacerbation of systemic lupus erythematosus. She had initially manifested with retinochoroiditis without vitritis, mild cognitive impairment and an isolated lung mass. These are completely different from the classic symptoms of toxoplasmosis that have been reported in patients with HIV infection and/or those after hematopoietic transplantation. Our case, together with previously reported cases, suggests the manifestation of toxoplasmosis that develops in systemic lupus erythematosus patients can be different from that seen in conventional cases and varies between individual patients. Our case highlights both the difficulty in and the importance of diagnosing toxoplasmosis in patients with systemic lupus erythematosus and provides helpful information to identify this rare, devastating, yet treatable disease. SN - 1477-0962 UR - https://www.unboundmedicine.com/medline/citation/30486727/Disseminated_toxoplasmosis_with_atypical_symptoms_which_developed_with_exacerbation_of_systemic_lupus_erythematosus_ L2 - http://journals.sagepub.com/doi/full/10.1177/0961203318815583?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -