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Febrile pancytopenia as uncommon presentation of disseminated toxoplasmosis after BMT

Bone Marrow Transplantation volume 47, pages 301–303 (2012)Cite this article

Toxoplasmosis disease is a life threatening complication after hematopoietic SCT (HSCT). Indeed, in a recent prospective EBMT survey of Toxoplasma gondii-seropositive recipients, its incidence was estimated at 6%. The incidence of toxoplasmosis infection, defined as detection of T. gondii DNA by PCR, was evaluated at 16%.1 Unfortunately in a previous retrospective study half of the toxoplasmosis disease cases reported after HSCT were diagnosed postmortem.2 We present here evidence for a misleading case of disseminated toxoplasmosis.

A 34-year-old Moroccan woman with very severe aplastic anemia unsuccessfully treated with immunosuppressive therapy underwent sibling allogeneic BMT. The conditioning regimen was fludarabine 30 mg/m2 i.v. for 4 days, CY 30 mg/kg i.v. for 4 days and anti-thymocyte globulin 5 mg/kg for 4 days. She received CYA as GVHD prophylaxis. The patient was seropositive for T.gondii while the donor was seronegative. She experienced very slow and incomplete neutrophil and platelet engraftment impeding use of cotrimoxazole for toxoplasmosis prophylaxis, and requiring repeated treatment with PEG G-CSF. A semi-monthly follow-up of toxoplasmosis reactivation by PCR analysis (LightCycler Roche Diagnostics, Basel, Switzerland) in peripheral blood was performed and remained negative. The method used was a TaqMan-based real-time PCR assay that amplifies a 529-bp (AF487550) unit repetitive DNA sequence in the T. gondii genome. In our hands, this technique can detect as few as three copies/mL.

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Authors and Affiliations

  1. Département d’Hématologie et Oncologie, Hôpital de Hautepierre, Centre Hospitalier Universitaire, Strasbourg, France

    P Bories, A Berceanu, K Bilger, R Herbrecht & B Lioure

  2. Laboratoire d’Hématologie cellulaire, Hôpital de Hautepierre, Centre Hospitalier Universitaire, Strasbourg, France

    E Zink

  3. Service de Radiologie 2, Hôpital de Hautepierre, Centre Hospitalier Universitaire, Strasbourg, France

    J F Mattern

  4. Institut de Parasitologie et de Pathologie Tropicale, Centre Hospitalier Universitaire, Strasbourg, France

    O Villard, E Candolfi & A Abou-Bacar

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  1. P Bories
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Correspondence to P Bories.

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Bories, P., Zink, E., Mattern, J. et al. Febrile pancytopenia as uncommon presentation of disseminated toxoplasmosis after BMT. Bone Marrow Transplant 47, 301–303 (2012). https://doi.org/10.1038/bmt.2011.62

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