Fatal toxoplasmic encephalitis triggered by anti-TNF therapy
Reactivation of a latent infection by the protozoan parasite Toxoplasma gondii can result in severe neurologic outcomes and even death. T. gondii reactivation cases have been strongly associated with acquired immunodeficiency syndrome, but other immunosuppressive situations are also associated. Anti...
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Elsevier
2025-02-01
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| Series: | Heliyon |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2405844025003457 |
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| author | Rodrigo A. Montoro Michael Moran Katherine A. Overmyer Andrew Periaccante Joshua J. Coon Swapnil Lanjewar Laura J. Knoll Rob Striker |
| author_facet | Rodrigo A. Montoro Michael Moran Katherine A. Overmyer Andrew Periaccante Joshua J. Coon Swapnil Lanjewar Laura J. Knoll Rob Striker |
| author_sort | Rodrigo A. Montoro |
| collection | DOAJ |
| description | Reactivation of a latent infection by the protozoan parasite Toxoplasma gondii can result in severe neurologic outcomes and even death. T. gondii reactivation cases have been strongly associated with acquired immunodeficiency syndrome, but other immunosuppressive situations are also associated. Anti-TNF-α therapy reliably triggers the reactivation of T. gondii latent cysts in mice models. Reactivation of T. gondii by TNF-a blockade is rare in humans though despite widespread use of TNF-a blockers. Serologic evidence of a possible latent T. gondii infection in humans is common worldwide, so why anti-TNF-α reactivation isn't more common is unknown. Here we present a 74-year-old woman who developed fatal cerebral toxoplasmosis after anti-tumor necrosis factor-α (TNF-α). After presenting to a local urgent care with confusion, a worsening cognitive status led to an emergency room visit. Computed tomography resulted in suspicion of metastatic disease leading to treatment with steroids. Lumbar puncture ruled out bacterial or viral meningitis. With continued cognitive decline, magnetic resonance imaging of the head revealed an increased number of lesions with T. gondii-associated ring-enhancing lesions. A brain biopsy confirmed the presence of T. gondii parasites. Despite standard treatment for toxoplasmosis, the patient expired. At least two possible factors may have contributed to this unfortunate outcome. First, in addition to her rheumatoid arthritis pathology, there is evidence of loss of immune resilience and abnormal T cell subsets. Second, some strains of T. gondii are more virulent than others. Post-mortem mass spectrometry and proteomic analysis of her cerebrospinal fluid show several T. gondii peptides. A literature review suggests that risks associated with anti-TNF-α therapy for patients who are seropositive for T. gondii have not been adequately recognized. We advise T. gondii seropositivity testing be considered before and after initiation of anti-TNF-α therapy as is done for other infections such as tuberculosis. |
| format | Article |
| id | doaj-art-4a40405134a34ee183ba5a9947a916bb |
| institution | Kabale University |
| issn | 2405-8440 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Heliyon |
| spelling | doaj-art-4a40405134a34ee183ba5a9947a916bb2025-01-31T05:11:59ZengElsevierHeliyon2405-84402025-02-01113e41965Fatal toxoplasmic encephalitis triggered by anti-TNF therapyRodrigo A. Montoro0Michael Moran1Katherine A. Overmyer2Andrew Periaccante3Joshua J. Coon4Swapnil Lanjewar5Laura J. Knoll6Rob Striker7Department of Medical Microbiology and Immunology, University of Wisconsin-Madison, 1550 Linden Drive, Madison, WI, 53706, United StatesDepartment of Medicine, University of Wisconsin-Madison, United StatesDepartment of Biochemistry, University of Wisconsin-Madison, United StatesDepartment of Biochemistry, University of Wisconsin-Madison, United StatesDepartment of Biochemistry, University of Wisconsin-Madison, United StatesDepartment of Medicine, University of Wisconsin-Madison, United StatesDepartment of Medical Microbiology and Immunology, University of Wisconsin-Madison, 1550 Linden Drive, Madison, WI, 53706, United StatesDepartment of Medical Microbiology and Immunology, University of Wisconsin-Madison, 1550 Linden Drive, Madison, WI, 53706, United States; Department of Medicine, University of Wisconsin-Madison, United States; Corresponding author. Department of Medical Microbiology and Immunology, University of Wisconsin-Madison, 1550 Linden Drive, Madison, WI, 53706, United States.Reactivation of a latent infection by the protozoan parasite Toxoplasma gondii can result in severe neurologic outcomes and even death. T. gondii reactivation cases have been strongly associated with acquired immunodeficiency syndrome, but other immunosuppressive situations are also associated. Anti-TNF-α therapy reliably triggers the reactivation of T. gondii latent cysts in mice models. Reactivation of T. gondii by TNF-a blockade is rare in humans though despite widespread use of TNF-a blockers. Serologic evidence of a possible latent T. gondii infection in humans is common worldwide, so why anti-TNF-α reactivation isn't more common is unknown. Here we present a 74-year-old woman who developed fatal cerebral toxoplasmosis after anti-tumor necrosis factor-α (TNF-α). After presenting to a local urgent care with confusion, a worsening cognitive status led to an emergency room visit. Computed tomography resulted in suspicion of metastatic disease leading to treatment with steroids. Lumbar puncture ruled out bacterial or viral meningitis. With continued cognitive decline, magnetic resonance imaging of the head revealed an increased number of lesions with T. gondii-associated ring-enhancing lesions. A brain biopsy confirmed the presence of T. gondii parasites. Despite standard treatment for toxoplasmosis, the patient expired. At least two possible factors may have contributed to this unfortunate outcome. First, in addition to her rheumatoid arthritis pathology, there is evidence of loss of immune resilience and abnormal T cell subsets. Second, some strains of T. gondii are more virulent than others. Post-mortem mass spectrometry and proteomic analysis of her cerebrospinal fluid show several T. gondii peptides. A literature review suggests that risks associated with anti-TNF-α therapy for patients who are seropositive for T. gondii have not been adequately recognized. We advise T. gondii seropositivity testing be considered before and after initiation of anti-TNF-α therapy as is done for other infections such as tuberculosis.http://www.sciencedirect.com/science/article/pii/S2405844025003457Anti-TNF-α therapyToxoplasmaEncephalitisProteomics |
| spellingShingle | Rodrigo A. Montoro Michael Moran Katherine A. Overmyer Andrew Periaccante Joshua J. Coon Swapnil Lanjewar Laura J. Knoll Rob Striker Fatal toxoplasmic encephalitis triggered by anti-TNF therapy Heliyon Anti-TNF-α therapy Toxoplasma Encephalitis Proteomics |
| title | Fatal toxoplasmic encephalitis triggered by anti-TNF therapy |
| title_full | Fatal toxoplasmic encephalitis triggered by anti-TNF therapy |
| title_fullStr | Fatal toxoplasmic encephalitis triggered by anti-TNF therapy |
| title_full_unstemmed | Fatal toxoplasmic encephalitis triggered by anti-TNF therapy |
| title_short | Fatal toxoplasmic encephalitis triggered by anti-TNF therapy |
| title_sort | fatal toxoplasmic encephalitis triggered by anti tnf therapy |
| topic | Anti-TNF-α therapy Toxoplasma Encephalitis Proteomics |
| url | http://www.sciencedirect.com/science/article/pii/S2405844025003457 |
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