Cerebral Toxoplasmosis in a Patient with Chronic Lymphocytic Leukemia Treated With Obinutuzumab- Chlorambucil

Despite therapeutic advances, infectious complications continue to play a significant role in the clinical course of patients with CLL. Cerebral toxoplasmosis is among the most common CNS infections in immunocompromised patients. Toxoplasma gondii can cause a life threatening CNS or disseminated infection, usually due to reactivation of a latent infection. We describe here the case of a 76 year-old man who developed toxoplasmic encephalitis after a treatment with obinutuzumab-chlorambucil for a CLL. He was admitted to the emergency room for confusion, agitation, Brocca aphasia, diplopia and left mydriasis seven months after the end of treatment with obinutuzumab-chlorambucil. Brain MRI showed at least eight intra-axial supra-tentorial lesions. A brain biopsy was performed and showed a florid toxoplasmosis. Rapidly, treatment with TMP-SMX was started and an improvement in the patient neurological condition was gradually observed. This is the first case of cerebral toxoplasmosis described after treatment with obinutuzumab-chlorambucil in a patient with CLL.