Cerebral toxoplasmosis associated with treatment with rituximab, azathioprine and prednisone for dermatomyositis

Abstract

We observed a severe case of cerebral toxoplasmosis in a 22‐year‐old woman diagnosed with dermatomyositis in 2016 in Venezuela, and treated with rituximab and azathioprine. The patient met clinical and microbiological criteria. Treatment with pyrimethamine and sulfadiazine was initiated, and the patient was discharged. She was rehospitalized with signs and symptoms of a manic episode. During hospitalization, the patient developed acute kidney injury related to sulfadiazine crystalluria. Finally, acute kidney injury was resolved and the patient was successfully discharged.

Neurotoxoplasmosis in the Immunocompetent: A Rare Occurrence

“…On the other hand, only approximately 10% to 20% of immunocompetent patients become symptomatic. Previous cases of cerebral toxoplasmosis have been reported in non-immunocompromised pregnant females, patients undertaking immunosuppressive therapy for their chronic diseases, and, rarely, in immunocompetent patients [ 6 , 7 ]. Our patient, an immunocompetent female, tested negative for pregnancy and HIV and had no history of immunosuppressive treatment.…”

Adult and juvenile dermatomyositis treatment

“…Immunosuppressives and immunomodulatory agents are commonly used in the treatment of inflammatory myositis 14 . These agents include corticosteroids, methotrexate, hydroxychloroquine, tacrolimus, cyclophosphamide, cyclosporine, azathioprine, mycophenolate mofetil, and immunoglbulins 4,15,16 …”

“…14 These agents include corticosteroids, methotrexate, hydroxychloroquine, tacrolimus, cyclophosphamide, cyclosporine, azathioprine, mycophenolate mofetil, and immunoglbulins. 4,15,16 TA B L E 1 Clinical features of dermatomyositis. Considering their anti-inflammatory and immunosuppressive action, corticosteroids are considered as first-line treatment for dermatomyositis.…”