TY  - JOUR
AU  - Morillas, Jose A.
AU  - Mossad, Sherif Beniameen
PY  - 2019
DA  - 2019/11/18
TI  - Toxoplasmosis: “An Often Forgotten Cause for Fever of Unknown Origin in Liver Transplant Recipients”. Case Report and Review of Literature
JO  - OBM Transplantation
SP  - 091
VL  - 03
IS  - 04
AB  - Toxoplasmosis in liver transplantation (LT) is uncommon, especially in the current era of universal prophylaxis with trimethoprim-sulfamethoxazole (TMP-SMX) for Pneumocystis jirovecii pneumonia (PJP). Here we present a case of a 55-year-old woman LT recipient, on dapsone or PJP prophylaxis due to sulfa allergy, who presented on day 25 after LT with fever, diarrhea and abdominal pain. Initially she was diagnosed with cytomegalovirus-associated colitis and was treated with intravenous ganciclovir, with good clinical response. On day 39 after LT she started having fevers again.  In the setting of Toxoplasma IgG seropositive donor, recipient’s toxoplasma serologies were checked, and IgM was positive with weakly positive IgG. Qualitative polymerase chain reaction in blood confirmed Toxoplasmosis. Donor-derived infection was considered “probable” because retrospective testing of stored pre-transplant recipient serum was not performed. No evidence of toxoplasma disease was documented. Patient was treated with pyrimethamine, clindamycin and leucovorin; later changed to atovaquone due to intolerance, with good clinical response. Our case highlights the importance of considering toxoplasmosis in the differential diagnosis of undifferentiated febrile illness, especially in LT recipients who are at high risk for primary infection with this organism and not receiving antimicrobial prophylaxis active against toxoplasmosis.
SN  - 2577-5820
UR  - https://doi.org/10.21926/obm.transplant.1904091
DO  - 10.21926/obm.transplant.1904091
ID  - Morillas2019
ER  -