急性淋巴细胞白血病移植后合并弓形虫脑病1例

A Case of Toxoplasma Encephalopathy after Acute Lymphoblastic Leukemia Transplantation

目的:探讨儿童急性淋巴细胞白血病移植后合并弓形虫脑病的临床症状、诊断方法及治疗方案,为降低弓形虫脑病死亡率提供参考。方法:回顾分析我院2023年确诊急性淋巴细胞白血病行造血干细胞移植后合并弓形虫脑病1例,并从各数据库学习相关文献。结果:患儿男,急性淋巴细胞白血病移植后有反复发热, 33天出现精神症状,后逐渐加重,有意识障碍,四肢肌力、肌张力下降,颅脑磁共振成像可见两侧基底节区及两侧大脑半球及小脑皮髓质交界处多发异常信号,血液及脑脊液宏基因组第二代测序检出刚地弓形虫,予复方磺胺甲噁唑、克林霉素、阿奇霉素治疗后好转,复查颅脑磁共振成像可见多发异常信号范围较前缩小,血液及脑脊液宏基因组第二代测序检出序列数也较前降低。结论:早期诊断和治疗可以降低HSCT受者中的弓形虫病死亡率。

Objective: To investigate the clinical symptoms, diagnosis and treatment of toxoplasma encephalopathy after transplantation in children with acute lymphoblastic leukemia, and to provide reference for reducing the mortality rate of toxoplasma encephalopathy. Methods: A case of toxoplasmosis complicated with acute lymphoblastic leukemia after hematopoietic stem cell transplantation in our hospital in 2023 was reviewed and analyzed, and related literature was learned from various databases. Results: The child was a male patient with recurrent fever after transplantation of acute lymphoblastic leukemia, and mental symptoms appeared after 33 days, which gradually worsened, with conscious disturbance, and decreased muscle strength and muscle tone of the limbs. Multiple abnormal signals in the basal ganglia of both sides of the brain and the cutis medulla junction of the cerebellum were detected by brain magnetic resonance imaging, and Toxoplasma gondii was detected by the next-generation sequencing of blood and cerebrospinal fluid. After treatment with trimethoprim-sulfamethoxazole, clindamycin, and azithromycin, the range of multiple abnormal signals was reduced by re-examination of brain magnetic resonance imaging, and the number of sequences detected by the next-generation sequencing in blood and cerebrospinal fluid was also reduced. Conclusion: Early diagnosis and treatment can reduce toxoplasmosis mortality in HSCT recipients.