亲缘单倍体造血干细胞移植后并发弓形虫脑病1例报道及诊疗分析

Toxoplasmic encephalitis after haploidentical hematopoietic stem cell transplantation:a case report and literature review

目的探索患者异基因造血干细胞移植(allogeneic hematopoiestem cell transplantation,allo-HSCT)后并发弓形虫脑病(Toxoplasmic encephalitis,TE)的临床特点。方法回顾性报道一例单倍体相合造血干细胞移植后并发弓形虫脑病的诊治过程,评估HSCT后弓形虫诊治策略的有效性。结果患者女性,34岁,急性T淋巴细胞白血病,行单倍体相合allo-HSCT。移植后46 d出现发热、视野缺损,行脑脊液检查后明确诊断为刚地弓形虫脑病。加用甲氧苄啶-磺胺甲恶唑(TMP-SMZ)治疗后患者症状逐渐好转,随访4月患者基本恢复正常。结论造血干细胞移植后并发弓形虫脑病是致命性并难诊断的并发症,头颅MRI有一定的特征,脑脊液二代测序对诊断本病具有重要价值,TMP-SMX对弓形体虫治疗安全有效。

Toxoplasmic encephalitis(TE)is a rare complication of allogeneic hematopoietic stem cell transplantation(allo-SCT).TE is complex and lacks characteristic clinical performance.Without timely diagnosis and disease specific treatment,TE is fatal.The aim of this study was to investigate the clinical characters of TE in patients with allo-HSCT after the stage of transplantation.We retrospectively report a case of concurrent TE after haplo-HSCT in a 34-year-old woman with T-acute lymphoblastic leukemia(T-ALL)who received transplantation from a haploidentical donor.At 46 days after transplantation,the patient showed fever and mental abnormalities.She was diagnosed with TE through cerebrospinal fluid(CSF)next-generation sequencing.She showed clinical improvement after trimethoprim-sulfamethoxazole(TMP-SMZ)treatment.The patient was followed up for 4 months and had returned to normal.TE after hematopoietic stem cell transplantation is a fatal complication.CSF next-generation sequencing has great value in TE diagnosis.Specific treatment with TMP-SMX is safe and beneficial.