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The Double-H Maze: A Robust Behavioral Test for Learning and Memory in Rodents
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A double threat: CNS toxoplasmosis and CMV encephalitis in a heart transplant recipient

Salwa Alhammadi1, Tianyu Zhang1, Aliya Szpindel1

  • 1McGill University.

Revista De La Facultad De Ciencias Medicas (Cordoba, Argentina)
|June 30, 2026
PubMed
Summary

A heart transplant patient experienced cognitive decline due to central nervous system toxoplasmosis and cytomegalovirus (CMV) encephalitis. Repeat brain biopsy was crucial for diagnosis, underscoring challenges in immunocompromised individuals.

Keywords:
magnetic resonance imagingtoxoplasmosis, cerebralimmunocompromised hostcytomegalovirus.

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Area of Science:

  • Neuroscience
  • Immunology
  • Infectious Diseases

Background:

  • Immunocompromised patients, particularly those with a history of organ transplantation, are susceptible to opportunistic central nervous system (CNS) infections.
  • Atypical presentations of CNS infections can pose significant diagnostic challenges, delaying appropriate treatment.
  • Early and accurate diagnosis is critical for managing CNS infections in immunocompromised hosts.

Purpose of the Study:

  • To report a case of central nervous system toxoplasmosis and cytomegalovirus (CMV) encephalitis in an immunocompromised heart transplant recipient.
  • To highlight the diagnostic difficulties encountered with atypical brain lesions in this patient population.
  • To emphasize the importance of considering repeat biopsies for definitive diagnosis when initial evaluations are inconclusive.

Main Methods:

  • A comprehensive infectious disease workup was performed.
  • Initial brain biopsy yielded inconclusive results.
  • A second brain biopsy was performed, leading to a definitive diagnosis.

Main Results:

  • The patient presented with cognitive decline and focal neurological deficits.
  • Imaging revealed atypical brain lesions.
  • The second brain biopsy confirmed co-infection with Toxoplasma gondii and cytomegalovirus (CMV) in the CNS.

Conclusions:

  • Central nervous system toxoplasmosis and CMV encephalitis can present atypically in immunocompromised patients.
  • Repeat neurosurgical biopsies may be necessary to establish a diagnosis when initial investigations are non-diagnostic.
  • Prompt diagnosis and treatment of CNS infections are vital, though outcomes can be poor even with intervention in severely immunocompromised individuals.