TITLE:
Toxoplasmosis-Associated Secondary Hemophagocytic Syndrome: A Case Report and Literature Review
AUTHORS:
Xiang Sun, Jiakui Zhang, Qianling Ye, Fan Wu, Yinwei Li, Qianshan Tao, Qing Zhang, Weiwei Zhu, Huiping Wang, Jinli Zhu, Zhimin Zhai
KEYWORDS:
Toxoplasmosis, Infection, Reactivation, Hemophagocytic Syndrome
JOURNAL NAME:
Open Journal of Blood Diseases,
Vol.10 No.3,
August
4,
2020
ABSTRACT: Background: Toxoplasmosis is an
extremely rare disease that occurs in the hosts contact with cat and dog
frequently. Most human acute infections go unnoticed in immunocompetent
individuals, and gradually transformed into chronic infection. However, while
host immunity significantly waned, the risk of reactivation of chronic
toxoplasma infection is greatly increased. Reactivation of latent toxoplasmic
infection often presents with fever, leukopenia, thrombocytopenia, neurological
signs and pneumonia. However, for the non-specific clinical and biological
signs and its fetal outcome, toxoplasmosis is often misdiagnosed and only
revealed at autopsy. Case Presenation: We report a case
hospitalized for a week history of cough, anorexia and fatigue with nasal
bleeding for a day. After hospitalization, broad-spectrum antibiotherapy was
started without a clear diagnosis of infection. Then the patient did a lot of
investigations to search the cause of infection, but there were no positive findings.
However, an unexpected discovery was detected from peripheral blood smears,
shows 1 - 3 μm in diameter, scattered, short and bow like microorganisms on Day 39 of
hospitalization. Combined with the medical history and clinical manifestation,
toxoplasmosis was diagnosed finally. Unfortunately, secondary hemophagocytic
syndrome (HPS) was diagnosed only two days after targeted anti-infection
therapy, and the patient died on Day 45 of hospitalization. Conclusions: Patient with unexplained long-term fever and neurological symptoms,
interstitial pneumonitis or myocarditis, toxoplasmosis should be positively
considered. Only early diagnosis and treatment can increase the possibility of
a successful cure and avoid other secondary diseases.