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Hyponatremia as the presenting feature of cerebral toxoplasmosis

Bone Marrow Transplantation volume 35, pages 1221–1222 (2005)Cite this article

Infections of the central nervous system (CNS) affect 3–4% of patients undergoing allogeneic hematopoietic stem cell transplantation (HSCT).1 Fungal, viral and parasitic organisms may be involved and these infections carry a high mortality. Aspergillus was thought to be the most common pathogen, while toxoplasma was considered rare.2 However, a report from Germany showed that toxoplasmosis was responsible for 75% of their cases.3 We encountered a case of cerebral toxoplasmosis where the presenting feature was isolated hyponatremia.

The prevalence of diagnosing toxoplasmosis after HSCT is influenced by the endemicity of the region, autopsy rate, and diagnostic techniques.2, 3 Nearly all cases have occurred in patients who are seropositive prior to conditioning. Other high-risk factors include GVHD and immunosuppressive therapy, as well as recipients of T-cell-depleted grafts.4 Most infections occurred between the 2nd and 6th month after HSCT, and many cases are disseminated at presentation. The CNS is the organ most often affected, but involvement of the lungs and myocardium are also found. The prognosis is poor due to the delay in diagnosis. Overall mortality reaches 80%, and many cases are discovered only at post mortem. However, for patients who have lived to receive more than 3 days of antitoxoplasma therapy, 48% showed a complete response and another 13% improved.3 This indicates the critical significance of early detection and institution of appropriate therapy.

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  1. Department of Pediatrics, MD Anderson Cancer Center, Houston, TX, USA

    O Duzovalı, M S Choroszy & K W Chan

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  1. O Duzovalı
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Duzovalı, O., Choroszy, M. & Chan, K. Hyponatremia as the presenting feature of cerebral toxoplasmosis. Bone Marrow Transplant 35, 1221–1222 (2005). https://doi.org/10.1038/sj.bmt.1704989

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