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Severe acute toxoplasmosis infection following ustekinumab treatment in a patient with psoriasis vulgaris
- Source :
- BMJ Case Rep
- Publication Year :
- 2019
- Publisher :
- BMJ, 2019.
-
Abstract
- A 26-year-old man undergoing therapy with 45 mg ustekinumab (Stelara) for chronic psoriasis vulgaris was referred by his general practitioner to an infectious diseases department for fatigue, fever, night sweating, generalised lymphadenomegaly and unexplained weight loss. Physical examination revealed bilateral occipital, cervical, axillary and inguinal lymphadenomegalies in addition to splenomegaly. Preliminary investigation revealed elevated Plasmodium lactate dehydrogenase and an inversion of the CD4/CD8 ratio. Whole-body spiral CT scanning with and without contrast showed splenomegaly and highlighted supradiaphragmatic and subdiaphragmatic lymphadenopathies. A complete Infectious Disease Test Panel revealed high levels of anti-Toxoplasma gondiiantibodies. Immunoglobulin G avidity was negative. Peripheral blood lymphocyte phenotyping was performed to exclude underlying lymphatic neoplasia. The diagnosis of severe acute toxoplasmosis infection in the setting of immune response modifiers was made. Ustekinumab was suspended indefinitely and the patient underwent monthly serological tests to monitor the immune response until all symptoms resolved and the serological testing was negative for Toxoplasma.
- Subjects :
- Adult
Male
0301 basic medicine
medicine.medical_specialty
Physical examination
Gastroenterology
Serology
030207 dermatology & venereal diseases
03 medical and health sciences
0302 clinical medicine
Internal medicine
Psoriasis
Ustekinumab
medicine
Humans
Avidity
Unexpected Outcome (Positive or Negative) Including Adverse Drug Reactions
medicine.diagnostic_test
business.industry
General Medicine
medicine.disease
Toxoplasmosis
030104 developmental biology
Lymphatic system
Infectious disease (medical specialty)
Acute Disease
Dermatologic Agents
business
Toxoplasma
medicine.drug
Subjects
Details
- ISSN :
- 1757790X
- Volume :
- 12
- Database :
- OpenAIRE
- Journal :
- BMJ Case Reports
- Accession number :
- edsair.doi.dedup.....a7cb29301bf1c0d5ea032b5858368683
- Full Text :
- https://doi.org/10.1136/bcr-2019-230415