Toxoplasma gondii is frequently found in AIDS and heart transplant patients, but it remains a rare cause of infection in renal transplant recipients which mostly occour within 3 months of transplantation and arise from reactivation of latent infection or from primary infection. Mortality rate is high due to to both a lack of clinical awareness and difficulties in confirming the diagnosis.
CASE REPORT
We report a case of 36 -year-old female who received renal transplant a year age due to chronic kidney disease. She was presented with progressive headache and unconsciousness and right hemiparesis. Unlike the pathognomic image of toxoplasmosis encephalitis which show multiple rings, the unenhanced cranial CT scan of this patient demonstrated multiple nodules with white matter edema on both hemisphere which resembled a metastatic process and MRI imaging also showed the same result. Laboratory tests and other imaging were performed but failed to determine the cancer of origin.
She was on immunosuppressive medication consisted of methylprednisolone and mycophenolic acid and CD4 count was <200 cells/mm3. The diagnosis of toxoplasmosis was suspected and toxoplasmosis treatment of pyrimethamine, clindamycin and folinic acid were initiated followed by co-trimoxazole. On day 21 of therapy the patient regain her conciousness. After three months of therapy she made a full neurological recovery with no significant impact on either cognitive or physical decline.