Cerebral Toxoplasmosis in Multiple Myeloma

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Abstract
A 55-year old white female with multiple myeloma controlled by combined chemotherapy developed somnolence, lethargy, focal neurological findings and died. At autopsy the diagnosis of active toxoplasmosis involving only the central nervous system was established by demonstrating acute inflammatory and necrotic histologic changes in the brain and the presence of toxoplasma cysts and free parasites. Localized cerebral toxoplasmosis in the adult probably results from a previous subclinical or clinical unrecognized generalized infection. Certain cases of toxoplasmosis have occurred in patients with advanced hematologic malignant diseases. In these the resistance to infection is decreased and the therapeutic measures used (corticosteroids, irradiation, antimetabolites and alkylating agents) interfere with immunologic response. As a result, there is an increased susceptibility to infection in these patients and an increased incidence of unusual fungal, viral and protozoal infections.