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Toxoplasmic encephalitis during mycophenolate mofetil immunotherapy of neuromuscular disease

Danilo R Bernardo1, Nizar Chahin1

  • 1Department of Neurology, University of North Carolina School of Medicine, Chapel Hill.

Neurology(R) Neuroimmunology & Neuroinflammation
|January 31, 2015
PubMed
Abstract

Insights

Immunotherapy with mycophenolate mofetil (MMF) can lead to severe toxoplasmic encephalitis (TE) in patients with neuromuscular disorders. This serious complication, even in non-HIV individuals, necessitates early recognition and further study for prevention.

Area of Science:

  • Neurology
  • Immunology
  • Infectious Diseases

Background:

  • Immunosuppressive therapies, including mycophenolate mofetil (MMF), are used in managing various autoimmune and neuromuscular disorders.
  • Opportunistic infections like toxoplasmic encephalitis (TE) are known risks in immunosuppressed populations.

Purpose of the Study:

  • To highlight the potential for severe complications, specifically TE, in patients with neuromuscular disorders undergoing long-term immunotherapy with MMF.
  • To underscore the importance of recognizing TE as a potential adverse effect of MMF in this patient group.

Main Methods:

  • A case series approach was employed, focusing on two patients with neuromuscular disorders receiving long-term MMF therapy.
  • Diagnosis of TE was confirmed through clinical presentation, characteristic MRI findings, and positive cerebrospinal fluid (CSF) PCR for *Toxoplasma gondii*.

Main Results:

  • Two patients, one with myasthenia gravis and another with inflammatory myopathy, developed severe TE while on MMF.
  • Despite standard treatment with pyrimethamine, sulfadiazine, and leucovorin for two months, both patients experienced no clinical improvement and ultimately died.

Conclusions:

  • Long-term immunotherapy with MMF can precipitate devastating toxoplasmic encephalitis in non-HIV patients with neuromuscular disorders.
  • Early recognition and consideration of TE are crucial for potentially improving outcomes in patients on MMF.
  • Further research is needed to evaluate the efficacy of screening and prophylaxis for toxoplasmosis in individuals with neuroimmunologic and autoimmune disorders receiving immunosuppressive therapy.

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