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Infectious Diseases
Disseminated toxoplasmosis infection 20 years post kidney transplant
  1. Shaun Chandler1,2,
  2. Lana Sundac2,3 and
  3. Carmel Hawley2,4
  1. 1Kidney Health Service, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
  2. 2The University of Queensland School of Medicine, Herston, Queensland, Australia
  3. 3Infectious Diseases, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
  4. 4Queensland Kidney Transplant Service, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
  1. Correspondence to Dr Shaun Chandler; shaun.chandler{at}health.qld.gov.au

Abstract

Kidney transplant recipients are at increased risk of opportunistic infections and malignancy, including space-occupying intracranial lesions. Here, we present a case of a patient presenting with multiple intracranial lesions in the context of a distant history of transplantation. MRI findings were consistent with a large subcortical enhancing lesion. Leading differentials included posttransplant lymphoproliferative disorder and cerebral cryptococcoma. Brain biopsy was undertaken along with PCR testing on tissue detected Toxoplasma gondii and Epstein-Barr virus (EBV) DNA. Cerebral toxoplasmosis was diagnosed based on characteristic histology and negative EBV immunohistochemistry. This case demonstrates the difficulties and complexities in reaching a diagnosis in immunocompromised patients and the importance of brain biopsy.

  • Renal transplantation
  • Systemic lupus erythematosus

https://doi.org/10.1136/bcr-2024-260412

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    Footnotes

    • Contributors The following authors were responsible for drafting of the text, sourcing and editing of clinical images, investigation of results, drawing original diagrams and algorithms and critical revision for important intellectual content: SC, CH and LS. The following authors gave final approval of the manuscript: SC, CH and LS.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.