Case Report: Immune Dysregulation Due to Toxoplasma gondii Reactivation After Allogeneic Hematopoietic Cell Transplant

Robert B. Lindell*, Michael S. Wolf, Alicia M. Alcamo, Michael A. Silverman, Daniel E. Dulek, William R. Otto, Timothy S. Olson, Carrie L. Kitko, Paisit Paueksakon, Kathleen Chiotos

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

4 Scopus citations

Abstract

Disseminated toxoplasmosis is an uncommon but highly lethal cause of hyperferritinemic sepsis after hematopoietic cell transplantation (HCT). We report two cases of disseminated toxoplasmosis from two centers in critically ill adolescents after HCT: a 19-year-old who developed fever and altered mental status on day +19 after HCT and a 20-year-old who developed fever and diarrhea on day +52 after HCT. Both patients developed hyperferritinemia with multiple organ dysfunction syndrome and profound immune dysregulation, which progressed to death despite maximal medical therapies. Because disseminated toxoplasmosis is both treatable and challenging to diagnose, it is imperative that intensivists maintain a high index of suspicion for Toxoplasma gondii infection when managing immunocompromised children, particularly in those with known positive T. gondii serologies.

Original languageEnglish
Article number719679
JournalFrontiers in Pediatrics
Volume9
DOIs
StatePublished - 10 Aug 2021
Externally publishedYes

Funding

FundersFunder number
Agency for Healthcare Research and QualityK12-HS026393
Thrasher Research Fund
Perelman School of Medicine, University of Pennsylvania

    Keywords

    • hematopoietic cell transplant
    • hyperferritinemia
    • immune dysregulation
    • multiple organ dysfunction syndrome
    • toxoplasmosis

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