Toxoplasma

4 year ALL patient who received 3 leukocyte transfusions; four weeks later she developed fever, rash and pneumonia, followed rapidly by bilateral pleural effusion, hepatitis, grand mal seizures and congestive heart failure. Antitoxoplasma HA, Sabin-Feldman DT, and indirect fluorescent IgM titers, which had been negative, rose to 1:4374, 1:8000, and 1:128 respectively. She responded to a 4 week course of pyrimethamine and sulfadiazine but had a ALL relapse and died. At postmortem examination, toxoplasma cysts and trophozoites were seen in histologic sections of heart, pancreas, brain, bone marrow, lymphonodes. A second patient, an 11 year girl with ALL received 3 units of leukocytes from the same donor; 4 weeks later she developed fever, massive splenomegaly and abdominal pain. She required a laparotomy and subsequently died with E. coli sepsis. PM examination of lung and heart tissue was positive for toxoplasma cysts. The donor was retrospectively tested and found to be seropositive, but attempts to isolate toxoplasma failed.