抗cd40单克隆抗体治疗肝移植患者并发眼脑弓形虫病

IF 1 Q4 INFECTIOUS DISEASES Case Reports in Infectious Diseases Pub Date : 2023-01-01 DOI:10.1155/2023/5565575
Roos Van Den Noortgate, Maja Kiselinova, Céline Sys, Geraldine Accou, Guy Laureys, Hans Van Vlierberghe, Frederik Berrevoet, Elke O Kreps
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引用次数: 0

摘要

刚地弓形虫是一种专性细胞内寄生原虫,通常引起轻微的急性感染,随后是潜伏的无症状期,伴有组织囊肿或慢性形式,伴复发性视网膜脉络膜炎。然而,由于潜伏组织囊肿的再激活或由于原发性感染,免疫功能低下的患者可引起播散性疾病。在此,我们报告一例罕见的双侧眼弓形虫病并发亚急性弓形虫脑炎的病例,患者为70岁,肝移植后接受抗cd40治疗。经前房液PCR及脑组织活检证实诊断,PET-CT未检出其他播散性病变部位。患者已接受磺胺甲恶唑-甲氧苄啶800/160 mg治疗,神经和眼部症状几乎完全缓解。医源性阻断CD40通路可能引起弓形虫中枢神经系统再激活的特殊易感性。
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Concurrent Ocular and Cerebral Toxoplasmosis in a Liver Transplant Patient Treated with Anti-CD40 Monoclonal Antibody.

Toxoplasma gondii, an obligate intracellular parasitic protozoon, usually causes a mild, acute infection followed by a latent asymptomatic phase with tissue cysts or a chronic form with recurrent retinochoroiditis. However, immunocompromised patients can cause disseminated disease due to the reactivation of the latent tissue cysts or due to a primary infection. Here, we present a rare case of bilateral ocular toxoplasmosis and concurrent subacute toxoplasma encephalitis in a 70-year-old patient on anti-CD40 treatment following his liver transplant. The diagnosis was confirmed by PCR of anterior chamber fluid and brain biopsy, and no other sites of disseminated disease were detected on PET-CT. The patient has been treated with sulfamethoxazole-trimethoprim 800/160 mg with virtually complete resolution of the neurological and ocular symptoms. Iatrogenic blockade of the CD40 pathway may elicit a particular susceptibility for CNS reactivation of T. gondii.

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