Toxoplasmic encephalitis during mycophenolate mofetil immunotherapy of neuromuscular disease

Danilo R. Bernardo, Nizar Chahin

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Objective: To show that immunotherapy with medications such mycophenolate mofetil (MMF) can cause serious complications in patients with neuromuscular disorders. Methods: Two patients with neuromuscular disorders on immunotherapy with long-term MMF who developed toxoplasmic encephalitis (TE) were included in this case series. Results: One patient with myasthenia gravis and one patient with inflammatory myopathy on immunotherapy with long-term MMF developed severe TE. Diagnosis was based on clinical presentation, MRI brain imaging characteristics, and CSF PCR positivity for Toxoplasma gondii. Both patients were treated with pyrimethamine, sulfadiazine, and leucovorin for 2 months without clinical improvement, and both died. Conclusions: Immunotherapy with medications such as MMF can cause devastating TE in non-HIV patients with neuromuscular disorders. Early consideration and recognition of this complication is important to possibly prevent unfavorable outcomes. The utility of screening and prophylaxis against toxoplasmosis in individuals with neuroimmunologic disorders and other autoimmune disorders who receive immunosuppressive therapy requires future study.

Original languageEnglish (US)
Article numbere63
JournalNeurology: Neuroimmunology and NeuroInflammation
Volume2
Issue number1
DOIs
StatePublished - Feb 1 2015
Externally publishedYes

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Mycophenolic Acid
Neuromuscular Diseases
Encephalitis
Immunotherapy
Sulfadiazine
Pyrimethamine
Myositis
Leucovorin
Myasthenia Gravis
Toxoplasmosis
Toxoplasma
Immunosuppressive Agents
Neuroimaging
Polymerase Chain Reaction

ASJC Scopus subject areas

  • Clinical Neurology
  • Neurology

Cite this

Toxoplasmic encephalitis during mycophenolate mofetil immunotherapy of neuromuscular disease. / Bernardo, Danilo R.; Chahin, Nizar.

In: Neurology: Neuroimmunology and NeuroInflammation, Vol. 2, No. 1, e63, 01.02.2015.

Research output: Contribution to journalArticle

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