[Toxoplasmosis of the central nervous systems after allogeneic stem cell transplantation]

Toxoplasmosis is a rare opportunistic protozoal infection, which may occur in patients after hematopoietic stem cell transplantation. This disease originates almost exclusively from reactivation of latent infection in seropositive recipients. We present a case report of one patient with diagnosis of acute myeloid leukemia undergoing two allogeneic stem cell transplantations at two years interval. The second transplantation was complicated by the development of the toxoplasmic encephalitis in early posttransplant course. The initial neurological symptoms included diplopia caused by the paresis of right side motor branches of the 3rd and 6th cranial nerves due to a compressive lesion in basal ganglia. Patient suddenly deteriorated after an epileptic seizure followed by a loss of consciousness, bilateral ptosis and right side mydriasis. Prolonged sopor and bilateral mydriasis appeared because of the further lesion progression in basal ganglia and compression of the 3rd cranial nerve. After targeted therapy of Toxoplasma gondii the patient's clinical status improved and she regained consciousness. Unfortunately, examination of bone marrow later revealed the relapse of leukemia. We compared risk factors of the latent reactivation of infection in immunocompromised patients with published data. It is of interest that the toxoplasmosis of the brain developed in this patient after the second transplantation.