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M9460570.TXT
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1994-06-25
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Document 0570
DOCN M9460570
TI [Toxoplasmosis peri-myocarditis as initial manifestation of highly
malignant non-Hodgkin's lymphoma]
DT 9408
AU Zweiker R; Eber B; Samonigg H; Reisinger EC; Kasparek A; Schumacher M;
Fruhwald FM; Apfelbeck U; Klein W; Medizinische Universitatsklinik Graz.
SO Z Kardiol. 1994 Mar;83(3):234-7. Unique Identifier : AIDSLINE
MED/94233840
AB A case report of a 28-year-old mother of two children with FUO is
presented. Physical examination revealed an anemic and febrile woman,
who lost 10 kg of weight during the past 3 months. Furthermore, two
lymphatic nodes with diameters below 1 cm were detected at the neck and
inguinal region. A search for origin of fever including evaluation of
foci, malignancies and laboratory investigations was primarily
unsuccessful. At day 7 after admission a pericardial murmur could be
heard. Echocardiography revealed a pericardial effusion, which increased
up to 4 cm during the following days, leading to hemodynamic impairment
and asystole. Immediate CR was successful, pericardial effusion was
aspirated. Looking for etiology of fever the presence of IgM-antibodies
against toxoplasma gondii by an ELISA test was possible. Therefore,
toxoplasmosis was diagnosed and a treatment-regimen comprising
pyrimethamin and sulfadiazin was initiated. Because of the threat to
life and very high titers of C-reactive protein, antibiotic therapy
(imipenem) was given additionally. An immunologic impairment was
excluded by normal ratio of CD4:CD8 of lymphocytes, normal HIV-test and
a nonsuspicious Jamshidi-biopsy of the bone marrow. However, in week 9
after admission lymphatic node-tumors suddenly appeared at the neck and
pulmonary hilus. After diagnostic exstirpation a malignant
non-Hodgkin-lymphoma (T-cell-type) was diagnosed. It is concluded that
in obscure pericardial effusion toxoplasmosis should be considered and
that this manifestation may be a precursor of malignant
non-Hodgkin-lymphoma.
DE Adult Biopsy Case Report Diagnosis, Differential Diagnostic Imaging
English Abstract Female Human Lymph Nodes/PATHOLOGY Lymphoma,
Large-Cell, Ki-1/*COMPLICATIONS/DIAGNOSIS Lymphoma,
T-Cell/*COMPLICATIONS/DIAGNOSIS Myocarditis/*DIAGNOSIS Neoplasm
Staging Opportunistic Infections/*DIAGNOSIS Pericarditis/*DIAGNOSIS
Toxoplasmosis/*DIAGNOSIS JOURNAL ARTICLE
SOURCE: National Library of Medicine. NOTICE: This material may be
protected by Copyright Law (Title 17, U.S.Code).