ArticleJournal of ophthalmic inflammation and infection2026
Bilateral visual impairment caused by Toxoplasma gondii encephalitis and ocular GVHD in a patient after allo-HSCT.
Article in Journal of ophthalmic inflammation and infection, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundCerebral toxoplasmosis is a rare but potentially fatal opportunistic infection in non-HIV immunocompromised patients, particularly after allogeneic hematopoietic stem cell transplantation (allo-HSCT). Diagnosis is often delayed due to nonspecific clinical manifestations. CASE PRESENTATION: We report a 66-year-old man with myelodysplastic syndrome that had transformed into secondary acute myeloid leukemia. Following remission induction with CPX-351, he underwent allo-HSCT and received ciclosporin A, mycophenolate mofetil, and corticosteroids for graft-versus-host disease prophylaxis. Standard cotrimoxazole prophylaxis was withheld because of hepatic intolerance and thrombocytopenia, and inhaled pentamidine was administered instead. Three months post-transplant, the patient presented with bilateral visual field deficits. Automated perimetry revealed a homonymous inferior quadrantanopia. Brain MRI demonstrated a solitary ring-enhancing lesion in the left optic radiation, and cerebrospinal fluid PCR confirmed Toxoplasma gondii. Treatment with sulfadiazine, pyrimethamine, and folinic acid was initiated, followed by long-term secondary prophylaxis. Despite residual visual impairment, the patient achieved clinical stability.
conclusionThis case underscores the diagnostic value of neuro-ophthalmologic examination and early neuroimaging in detecting opportunistic CNS infections. It also highlights the challenges of prophylactic decision-making in immunocompromised patients when cotrimoxazole is contraindicated. Individualized immunosuppressive and prophylactic strategies, along with multidisciplinary care, were key to successful management.
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