Toxoplasmosis-associated central nervous system vasculitis accompanied by multiple cerebral hemorrhages developing subsequent to cord blood transplantation

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  • OHTA Takanori
    Department of Internal Medicine, Kitakyushu Municipal Medical Center
  • IMANAGA Hiroshi
    Department of Internal Medicine, Kitakyushu Municipal Medical Center
  • OKU Seidou
    Department of Internal Medicine, Kitakyushu Municipal Medical Center
  • KUSUMOTO Hirotake
    Department of Internal Medicine, Kitakyushu Municipal Medical Center Department of Gastroenterology Medicine, Nanpuh Hospital
  • SUGIO Yasuhiro
    Department of Internal Medicine, Kitakyushu Municipal Medical Center
  • TAMIYA Sadafumi
    Department of Pathological Diagnosis, Kitakyushu Municipal Medical Center
  • KUBO Yasutaka
    Department of Hematology, Shimonoseki City Hospital
  • OGAWA Ryosuke
    Department of Hematology and Oncology, Japan Community Health Care Organization, Kyushu Hospital
  • HIKOSAKA Kenji
    Department of Infection and Host Defense, Graduate School of Medicine, Chiba University
  • NOROSE Kazumi
    Department of Infection and Host Defense, Graduate School of Medicine, Chiba University
  • OHNO Yuju
    Department of Internal Medicine, Kitakyushu Municipal Medical Center

Bibliographic Information

Other Title
  • 臍帯血移植後に多発性脳出血を来したトキソプラズマ関連中枢神経系血管炎
  • 症例報告 臍帯血移植後に多発性脳出血を来したトキソプラズマ関連中枢神経系血管炎
  • ショウレイ ホウコク サイタイケツ イショク ゴ ニ タハツセイ ノウシュッケツ オ キタシタ トキソプラズマ カンレン チュウスウ シンケイケイ ケッカンエン

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Abstract

<p>A 57-year-old man with high-risk myelodysplastic syndrome underwent umbilical cord blood transplantation. He began receiving steroids on day 14 for acute graft-versus-host disease, and experienced dizziness on day 75 during gradual dose reduction. Multiple hemorrhages were observed in the cerebrum, cerebellum, and brainstem. His bleeding increased, and he underwent a brain biopsy on day 91. Subsequently, he was diagnosed with central nervous system vasculitis (CNSV) on the basis of the observed aggregation of mature CD3+ lymphocytes around small vessels and vascular wall invasion by lymphocytes and macrophages. After receiving high-dose steroid therapy, cerebral hemorrhage stopped; however, dysphasia occurred on day 113 and the patient died of cerebral edema on day 128. Toxoplasma DNA and tachyzoites were detected in the brain biopsy specimen during additional examinations; therefore, we suspected that the toxoplasmosis was related to the onset of CNSV. CNSV is a rare, rapidly progressing disease that may present as a fatal post-transplantation central nervous system complication. Investigating the causes of CNSV, including CNSV associated with toxoplasmosis, is critically important for improving the prognosis of patients with CNSV.</p>

Journal

  • Rinsho Ketsueki

    Rinsho Ketsueki 60 (2), 118-123, 2019

    The Japanese Society of Hematology

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