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Ann Hematol Oncol. 2018; 5(8): 1223.
Disseminated Toxoplasmosis with Bone Marrow Involvement
Collin K Chin1,2 and Jill Finlayson1,3*
¹PathWest Laboratory Medicine Australia
²Department of Hematology, Sir Charles Gairdner Hospital, Western Australia
³University of Western Australia
*Corresponding author: Jill Finlayson, PathWest Laboratory Medicine, QEII Medical Centre, Nedlands, Western Australia
Received: November 08, 2018; Accepted: November 21, 2018; Published: November 08, 2018
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A 61-year-old man with acute lymphoblastic leukemia on maintenance oral mercaptopurine and methotrexate presented with confusion, night sweats and cough. Laboratory work-up showed pancytopenia with elevated inflammatory markers and liver enzymes. Computerized tomography showed trace pericardial fluid and small pleural effusions without evidence of infection. Broad-spectrum antimicrobial therapy was commenced and bone marrow (BM) biopsy was performed. The BM aspirate smear was hypocellular without evidence of haemophagocytosis or leukemic relapse. Examination demonstrated granulocytes with crescentshaped intracellular inclusions with prominent oval nuclei (panels A/B, Giemsa stain). Trephine biopsy showed similar findings with increased eosinophilic activity (panel C, hematoxylin & eosin stain). Serology was positive for Toxoplasma immunoglobulin M and immunoglobulin G of 5.0IU/mL (positive >3.0IU/mL). Polymerase chain reaction and sequencing analyses were positive for Toxoplasma gondii. Human immunodeficiency virus serology was negative. The patient deteriorated within 48 hours due to cardiac tamponade from disseminated toxoplasmosis and subsequently died.
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