Late presentation of toxoplasmosis in renal transplant recipients

Abstract

Toxoplasma gondii is a rare cause of infection in renal transplant recipients and usually occurs within 3 months of transplantation, this being the period of maximum immunosuppression. We report two cases of toxoplasmosis presenting several years after transplantation. One patient developed Toxoplasma retinitis 4 years after renal transplantation and lost peripheral vision in his affected eye. Another developed cerebral toxoplasmosis 6 years following his second renal transplant but did not survive despite treatment. These cases highlight the need for a high index of suspicion of toxoplasmosis as a potential diagnosis even during the later stages of the post-transplant period as survival is poor without early recognition and treatment.

Keywords: renal transplantation; toxoplasmosis.

Fig. 1

Unenhanced CT scan of the brain showing areas of low attenuation affecting the white matter of both temporal lobes and the left frontoparietal lobe, with mild mass effect.

Fig. 2

MRI of the brain with contrast highlighting multiple ring-enhancing lesions.