Cerebral toxoplasmosis after rituximab therapy for splenic marginal zone lymphoma: a case report and review of the literature
Bibliographic record
Abstract
Introduction: Toxoplasma gondii is a parasite estimated to infect one-third of the global population, surviving in tissues in a latent form. Although cerebral toxoplasmosis is predominantly recognized as an opportunistic infection in hosts immunocompromised secondary to human immunodeficiency virus or bone marrow transplant, there is increasing recognition that this infection can occur in patients receiving immunomodulating agents such as mAb therapy targeted against T-cells, B-cells and TNF. The indications for these therapies are expanding, resulting in a larger at-risk population for this rare but serious and potentially avoidable complication. Case Presentation: This is one of the few case reports of cerebral toxoplasmosis following rituximab-based chemotherapy in a patient with a haematological malignancy. We describe a patient presenting with focal neurological deficits and radiographic evidence of multi-focal cerebral ring-enhancing lesions following completion of rituximab therapy for splenic marginal zone lymphoma. Brain biopsy confirmed a diagnosis of cerebral toxoplasmosis. Antibiotic treatment with trimethoprim/sulfamethoxazole resulted in near-complete radiological and clinical resolution of the neurological deficits, and a return to baseline functional status. Conclusion: Reactivation of toxoplasmosis resulting in intracerebral disease is a potential severe and preventable complication of rituximab therapy. Further studies are required to assess the need both for screening and prescribing primary chemoprophylaxis for toxoplasmosis when initiating rituximab therapy.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".