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NDT Plus Advance Access originally published online on October 18, 2008
NDT Plus 2008 1(6):429-432; doi:10.1093/ndtplus/sfn159
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© The Author [2008].
The online version of this article has been published under an open access model. Users are entitled to use, reproduce, disseminate, or display the open access version of this article for non-commercial purposes provided that: the original authorship is properly and fully attributed; the Journal and Oxford University Press are attributed as the original place of publication with the correct citation details given; if an article is subsequently reproduced or disseminated not in its entirety but only in part or as a derivative work this must be clearly indicated. For commercial re-use, please contact journals.permissions@oxfordjournals.org

Unusual presentation of primary toxoplasmosis infection in a kidney-transplant patient complicated by an acute left-ventricular failure

Benjamin Hébraud1, Nassim Kamar1,2, Jean-Sébastien Borde1, Marie-Hélène Bessières3, Michel Galinier4 and Lionel Rostaing1,5

1 Department of Nephrology, Dialysis and Multiorgan Transplantation, University Hospital, CHU Rangueil
2 INSERM U858, IFR 31
3 Laboratory of Parasitology
4 Department of Cadiology, CHU Rangueil, 1 av. J. Poulhes, TSA 50032
5 INSERM U563, IFR 30, 330 Avenue de Grande-Bretagne, TSA 40031, 31059 Toulouse Cédex 9, France

Correspondence: Correspondence and offprint requests to: Lionel Rostaing, CHU Rangueil, Service de Néphrologie, Transplantation d’Organes, Dialyse, 1 avenue Jean Poulhès, TSA 50032, 31059 Toulouse Cédex 9, France. Tel: +33-5-6132-26-84; Fax: +33-5-61-32-28-64; E-mail: rostaing.l{at}chu-toulouse.fr


  Abstract

Although primary toxoplasmosis is a rare event following kidney transplantation, it can be life threatening. This report describes this complication. The patient presented with high-grade fever, haemolytic anaemia and haemophagocytic-syndrome-related pancytopaenia. Toxoplasma gondii diagnosis was ascertained by blood and bone-marrow PCR assays. After 6 weeks with Clindamycin plus pyrimethamine therapies and despite negativation of T. gondii blood PCR assay, the patient developed left-ventricular failure. After adding sulfamethoxazole/ trimethoprim, ramipril, digoxine, bisoprolol and spironolactone, he progressively recovered. Anti-T. gondii therapy was continued for 6 months. Four years later he received a third kidney allograft: at that time anti-T. gondii antibodies had become negative. The outcome was uneventful despite immunosuppression but with inclusion of sulfamethoxazole/trimethoprim prophylaxis. More than 3 years after the third kidney transplantation the patient has had no toxoplasmosis reactivation. This case report highlights that T. gondii can be the cause of myocarditis in a renal transplant recipient.

Key Words: chronic kidney disease • haemophagocytic syndrome • heart failure • toxoplasmosis • myocarditis

Received for publication April 17, 2008. Accepted for publication September 18, 2008.


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