Reactivation toxoplasmic retinochoroiditis in patients undergoing bone marrow transplantation : is there a role for chemoprophylaxis ?

• Published in: Bone marrow transplantation (Basingstoke) Vol. 15; no. 6; pp. 983 - 987
• Main Authors: PEACOCK, J. E, GREVEN, C. M, CRUZ, J. M, HURD, D. D
• Format: Journal Article
• Language: English
• Published: Basingstoke Nature Publishing Group 01.06.1995
• Subjects: Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Animals; Antibodies, Protozoan - blood; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Antiprotozoal Agents - therapeutic use; Biological and medical sciences; Bone Marrow Transplantation - adverse effects; Bone marrow, stem cells transplantation. Graft versus host reaction; Chorioretinitis - drug therapy; Chorioretinitis - etiology; Chorioretinitis - parasitology; Chorioretinitis - prevention & control; Combined Modality Therapy; Fatal Outcome; Humans; Immunocompromised Host; Lymphoma, Large B-Cell, Diffuse - complications; Lymphoma, Large B-Cell, Diffuse - drug therapy; Lymphoma, Large B-Cell, Diffuse - therapy; Lymphoma, Non-Hodgkin - complications; Lymphoma, Non-Hodgkin - drug therapy; Lymphoma, Non-Hodgkin - therapy; Male; Medical sciences; Middle Aged; Opportunistic Infections - etiology; Opportunistic Infections - prevention & control; Prednisone - therapeutic use; Pyrimethamine - therapeutic use; Sulfadiazine - therapeutic use; Toxoplasma - immunology; Toxoplasma - physiology; Toxoplasmosis, Ocular - drug therapy; Toxoplasmosis, Ocular - etiology; Toxoplasmosis, Ocular - prevention & control; Transfusions. Complications. Transfusion reactions. Cell and gene therapy; Human; Choroiditis; Reactivation; Retinopathy; Transfusion; Malignant hemopathy; Uvea disease; Non Hodgkin lymphoma; Case study; Eye disease; Autograft; Association; Treatment; Lymphoproliferative syndrome; Bone marrow; Adult; Graft; Retinitis
• ISSN: 0268-3369; 1476-5365

The objective of this study was to report the occurrence of reactivation ocular toxoplasmosis in bone marrow transplant (BMT) recipients and to propose guidelines for identification and chemoprophylaxis of high-risk patients. The study design was a series of cases from the tertiary care university hospital which has an active BMT program. The patients were two recipients of autologous BMTs with past histories of toxoplasma retinochoroiditis who developed symptomatic reactivation of ocular toxoplasmosis as documented by formal opthalmologic examination in the early post-transplant period. Opthalmoscopic examinations in the two patients with non-Hodgkin's lymphoma who received autologous transplants and then developed decreased visual acuity in the first week after transplant revealed recurrent retinochoroiditis adjacent to old toxoplasma lesions. Pre-transplant eye examinations in both patients had demonstrated only inactive chorioretinal scars. Therapy with sulfadiazine, pyrimethamine and prednisone ultimately led to resolution of retinitis in both patients. BMT recipients who are seropositive for antibody to T. gondii and have findings consistent with previous toxoplasma retinochoroiditis on pre-transplant ophthalmologic examination appear to be at risk for reactivation of ocular toxoplasmosis in the early post-transplant period and may warrant preventive chemoprophylaxis for toxoplasmosis.