Abstract: FR-PO759
Ocular Toxoplasmosis After Kidney Transplant
Session Information
- Post-Transplantation and Case Reports
November 03, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2102 Transplantation: Clinical
Authors
- Belal, Amer Ashaab, University of Florida College of Medicine, Gainesville, Florida, United States
- Slater, Andrew, University of Florida College of Medicine, Gainesville, Florida, United States
- Chen, Jinghua, University of Florida College of Medicine, Gainesville, Florida, United States
- Santos, Alfonso, University of Florida College of Medicine, Gainesville, Florida, United States
- Leghrouz, Muhannad, University of Florida College of Medicine, Gainesville, Florida, United States
Introduction
Toxoplasmosis (TOXO) is a zoonotic infection where the parasite persists dormant within tissue cysts and can result in a life-threatening infection in immunocompromised patients. Acute retinal necrosis (ARN) is a vision-threatening necrotizing retinitis with the most common cause being due to the herpes virus family. We describe a case of ocular TOXO after a kidney transplant (KT).
Case Description
A 58-year-old woman with a history of ESRD due to diabetes and hypertension received a deceased donor KT and was directed to the ER by ophthalmology for severe vision loss (counting finger vision) 2 months post-transplant (PT). At transplant, both recipient and donor were positive for Toxoplasma, CMV, and EBV IgG antibodies and induction was with alemtuzumab followed by triple tacrolimus-mycophenolate-prednisone regimen. Her PT course was complicated by slow graft function, persistent hyperkalemia and neutropenia necessitating switching of TMP/SMZ to pentamidine and BK viremia requiring immunosuppression reduction at the 1st and 2nd months PT, respectively. Based on a funduscopic exam, the ophthalmologist diagnosed her with ARN (Figure 1). She was empirically started on intravitreal ganciclovir and IV followed by PO acyclovir, which was changed to Valtrex. Subsequently, her aqueous sample, which was negative for CMV, VZV, and HSV, tested positive for TOXO PCR. She was started on induction dose Bactrim DS PO BID for 6 weeks followed by lifelong Bactrim prophylaxis. Her steroids were increased to reduce ocular inflammation and tissue damage. On follow-up, her ocular pain improved but significant vision impairment in the left eye (20/200) remains.
Discussion
A high index of suspicion for toxoplasma disease should be maintained when prophylaxis without coverage for toxoplasma is used in kidney transplants where donor and/or recipient has positive toxoplasma serology.