SHM Converge Scientific Abstract ePoster Gallery-Acute Toxoplasmosis Pneumonia in a Renal Transplant Recipient

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This case report describes a renal transplant recipient in his 50s, maintained on mycophenolate, tacrolimus, and low-dose prednisone, who presented with two weeks of fever, fatigue, poor oral intake, diaphoresis, weight loss, cough, and intermittent headaches. On evaluation, he was febrile and hypoxic with acute on chronic kidney injury. Chest CT showed bilateral patchy reticular and ground-glass opacities. Initial respiratory viral testing was negative, and despite broad-spectrum antibiotics, his fever and hypoxia worsened, prompting transfer for bronchoscopy and further workup.<br /><br />Extensive testing revealed HIV-negative status, positive Toxoplasma IgM with negative IgG, serum PCR positive for Toxoplasma gondii, and elevated microbial cell-free DNA testing. Bronchoalveolar lavage confirmed toxoplasmosis pneumonia by quantitative PCR. He was diagnosed with acute pulmonary toxoplasmosis and treated with pyrimethamine, atovaquone, and leucovorin for six weeks, followed by lifelong suppressive therapy. His symptoms improved after appropriate treatment.<br /><br />The report highlights that Toxoplasma gondii is an intracellular protozoan typically transmitted through oocysts, undercooked meat, or organ transplantation. While often asymptomatic in immunocompetent hosts, it can cause severe disease in immunosuppressed patients, including cerebral, cardiac, ocular, and rare pulmonary involvement. In this patient, the likely source was recent consumption of venison prepared by a friend. Latent transplant-related infection was considered less likely because the infection occurred seven years after transplantation and the serology suggested an acute infection.<br /><br />The authors emphasize the importance of considering unusual infections in immunosuppressed, non-HIV patients and the value of a detailed exposure history in identifying the source of infection.

Asset Subtitle

Kyle Rau

Meta Tag

Author List Fergus Peacock, Jose Morillas, Kyle Rau, Ryan C. Crane

Category Clinical Vignettes

Concept Toxoplasmosis

Concept Pneumonia

Concept Immunosuppression

Concept Pyrimethamine

Concept Kidney Transplantation

Distinguished Non-Finalist

Presenter Organization Corewell Health West

Presenting Author Kyle Rau

Track Adult

Keywords

renal transplant

toxoplasmosis pneumonia

immunosuppressed patient

tacrolimus

mycophenolate

prednisone

ground-glass opacities

bronchoalveolar lavage

Toxoplasma gondii

acute pulmonary toxoplasmosis

Toxoplasmosis

Pneumonia

Immunosuppression

Pyrimethamine

Kidney Transplantation