[Non-Hodgkin's lymphoma with Toxoplasma encephalitis]

Rinsho Ketsueki. 1999 Jul;40(7):563-7.
[Article in Japanese]

Abstract

A 62-year-old man was admitted to our hospital due to fever and systemic lymph-node swelling on June 9, 1998. He was given a diagnosis of non-Hodgkin's lymphoma (diffuse mixed T cell lymphoma) with involvement of mediastinum and para-aortic lymph nodes, pleura, peritoneum, and bone marrow. After diagnosis, combined chemotherapy (CHOP regimen) was started. On day 11, the patient's consciusness level suddenly deteriorated. A brain computed tomographic scan showed no abnormal findings. A cytospin smear of cerebrospinal fluid disclosed tachyzoides (Toxoplasmic bodies), thus yielding a diagnosis of Toxoplasma encephalitis. Oral sulfadoxine pyrimethamine rapidly alleviated the patient's consciousness disturbance. One month later, a cytospin smear and RT-PCR analysis of cerebrospinal fluid detected no tachyzoides. Complete remission of lymphoma was achieved after 2 courses of CHOP therapy. Toxoplasma encephalitis should be considered a potential cause of consciousness disturbance in immunocompromised hosts, such as patients with malignant lymphoma. Cytospin smears of cerebrospinal fluid are a useful tool for the early diagnosis of Toxoplasma encephalitis.

Publication types

  • Case Reports
  • English Abstract

MeSH terms

  • Animals
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use
  • Antiprotozoal Agents / administration & dosage
  • Cyclophosphamide / administration & dosage
  • Doxorubicin / administration & dosage
  • Drug Administration Schedule
  • Drug Combinations
  • Encephalitis / drug therapy
  • Encephalitis / etiology
  • Encephalitis / parasitology*
  • Humans
  • Lymphoma, T-Cell / complications*
  • Lymphoma, T-Cell / drug therapy
  • Male
  • Middle Aged
  • Prednisolone / administration & dosage
  • Pyrimethamine / administration & dosage
  • Remission Induction
  • Sulfadoxine / administration & dosage
  • Toxoplasmosis, Cerebral / drug therapy
  • Toxoplasmosis, Cerebral / etiology
  • Toxoplasmosis, Cerebral / parasitology*
  • Vincristine / administration & dosage

Substances

  • Antiprotozoal Agents
  • Drug Combinations
  • fanasil, pyrimethamine drug combination
  • Vincristine
  • Doxorubicin
  • Sulfadoxine
  • Cyclophosphamide
  • Prednisolone
  • Pyrimethamine

Supplementary concepts

  • VAP-cyclo protocol