Hemophagocytic lymphohistiocytosis induced by Toxoplasma gondii infection diagnosed by a bone marrow biopsy and DNA next-generation sequencing in an allogeneic hematopoietic stem cell transplant recipient

Karam M. Obeid, Bartosz Grzywacz, Patricia Ferrieri, Sophie S Arbefeville, Arne Slungaard, Brian Betts

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

In the United States, toxoplasmosis following allogeneic hematopoietic stem transplant (allo-HCT) is very rare with a rate only between 0.5% and 2%. The reported rates of hemophagocytic lymphohistiocytosis (HLH) following allo-HCT range between 0.3% and 17%. Secondary HLH due to toxoplasmosis infection is extremely rare. Herein, we report a case of secondary HLH due to toxoplasmosis following allo-HCT. The diagnosis was reached by a bone marrow biopsy and confirmed by DNA next generation sequencing and immunohistochemical (IHC) staining. The IHC staining included CD1a, a stain previously known to react with cells infected by Leishmania, here we show CD1a staining of macrophages infected with Toxoplasma gondii. Our report highlights the utility of bone marrow biopsy in diagnosing parasitic infection underlying HLH in post-transplant settings. The pre-transplant evaluation of patients from low endemic countries, is a great opportunity to obtain a travel history to determine the risks and the preventative measures against opportunistic infections including toxoplasmosis.

Original languageEnglish (US)
Article numbere13610
JournalTransplant Infectious Disease
Volume23
Issue number4
Early online dateMar 30 2021
DOIs
StatePublished - Aug 2021

Bibliographical note

Publisher Copyright:
© 2021 Wiley Periodicals LLC.

Keywords

  • HLH
  • hematopoietic stem cell transplant
  • hemophagocytic lymphohistiocytosis
  • toxoplasmosis

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