Disseminated toxoplasmosis with pulmonary involvement after heart transplantation

We report a case of pulmonary toxoplasmosis after heart transplant despite the prophylactic anti-toxoplasmic treatment that was given but was not sufficient to prevent toxoplasmosis. However, the patient survived thanks to early diagnosis confirmed by polymerase chain reaction on blood and by serological techniques, and early treatment. Infection with Toxoplasma gondii is a possible complication in cardiac recipients in European heart transplantation programs, where the overall seroprevalence is high (1). Infection with T. gondii may be transmitted with the transplanted organ to non-infected recipients (donor seropositive/recipient seronegative - D + /R - ) or may be caused by reactivation during immunosuppression in cases with pretransplant infection. The study by Gallino et al. (1) observed that organ-transmitted infection was more frequent (61%) and more often associated with acute disease than reactivation of latent infection (7%). In the Montoya et al. study (2), 25% (4/16) of the D + /R - patients who were not taking prophylactic drug developed toxoplasmosis, and all died from the infection. Clinical presentations include meningoencephalitis, brain abscess, pneumonia, myocarditis, pericarditis, hepatitis, retinochoroiditis (3), and disseminated infection (4). The prevention of toxoplasmosis after organ transplantation is an important component of post-transplantation management (5). We report the case of a patient who suffered from - and survived - acute toxoplasmosis that developed after heart transplant and despite prophylactic anti-toxoplasmic treatment. The accuracy of prophylaxis and biological diagnosis is then discussed.