Detection and treatment of cerebral toxoplasmosis in an aplastic pediatric post-allogeneic hematopoietic cell transplant patient: a case report

• Main Authors: Danielle Brewer, Margaret L. MacMillan, Mark R. Schleiss, Satja Issaranggoon Na Ayuthaya, Jo-Anne Young, Christen L. Ebens
• Format: Article
• Language: English
• Published: BMC 2021-09-01
• Series: BMC Infectious Diseases
• Subjects: Toxoplasmosis; Allogeneic hematopoietic cell transplantation; Severe aplastic anemia; Immune mediated cytopenia; Cell-free DNA; Case report
• Online Access: https://doi.org/10.1186/s12879-021-06650-2

Abstract Background Cerebral toxoplasmosis infection presents with non-specific neurologic symptoms in immunocompromised patients. With lack of measurable adaptive immune responses and reluctance to sample affected brain tissue, expedient diagnosis to guide directed treatment is often delayed. Case presentation We describe the use of cerebrospinal fluid polymerase chain reaction and plasma cell-free DNA technologies to supplement neuroimaging in the diagnosis of cerebral toxoplasmosis in an immunocompromised pediatric patient following allogeneic hematopoietic cell transplantation for idiopathic severe aplastic anemia. Successful cerebral toxoplasmosis treatment included antibiotic therapy for 1 year following restoration of cellular immunity with an allogeneic stem cell boost. Conclusions Plasma cell-free DNA technology provides a non-invasive method of rapid diagnosis, improving the likelihood of survival from often lethal opportunistic infection in a high risk, immunocompromised patient population.