Neurotoxoplasmosios after rituximab therapy in diffused proliferative glomerulonephritis patient

Abstract

Introduction: CNS toxoplasmosis may involve patients receiving immunosuppressive drugs. Due to sharing common symptoms, it is difficult to distinguish neurotoxoplasmosis from other CNS disorders. This report investigated an unusual neurotoxoplasmosis in a patient with glomerulonephritis receiving rituximab. Case Presentation: The clinical case was a 23-year old male patient admitted with fever, vomiting, and acute progressive headache. He received rituximab (375 mg/m2 body surface area for four doses) and prednisolon (1 mg/kg) for diffuse proliferative glomerulonephritis (DPG) two months ago. The MRI results showed subretinal mass, and multifocal brain and retinal abscesses. The possible symptoms of toxoplasmosis were treated with vancomycin, ceftriaxone, metronidazole, and cotrimoxazole. Conclusions: In patients treated with rituximab, neurological manifestations can be a definitive diagnosis for cerebral toxoplasmosis. Since it is a serious and even fatal disease, patients with unknown neurological symptoms should receive empirical treatment.