Varicella-like cutaneous toxoplasmosis in a patient with aplastic anemia

Abstract

A 60-year-old patient with aplastic anemia presented with vesicular varicella-like skin lesions on her face, arms, legs, back, and abdomen. However, diagnosis for herpetic infection was negative. Findings of a skin biopsy led to a tentative histologic diagnosis of toxoplasmosis, and infection with Toxoplasma gondii was confirmed by immunohistochemistry and PCR. Cutaneous toxoplasmosis is a rare finding in immunocompromised patients and might mimic other infectious diseases, and vesicular lesions associated with toxoplasmosis have not been reported previously.

Fig 1

(A) Macroscopic view of disseminated vesicles with sparse surrounding erythema on the trunk. (B) Microscopic appearance of the skin lesion. It shows proliferative forms of T. gondii and intercellular edema of the epidermis without inflammatory reactions. HE staining was used. (C) Brown stain shows the presence of T. gondii detected by a polyclonal antibody. Original magnification, ×63.

Fig 2

Detection of T. gondii in serum samples. T. gondii genomic DNA was detected by real-time PCR with hydrolysis probes targeting DNA sequence AF146527. The PCR assay included an internal control and was done on a BD MAX (Becton, Dickinson) in the PCR-only mode. Quantification was achieved by running DNA dilutions from manually counted T. gondii RH parasites. Indicated are the numbers of samples analyzed at the respective time points and the number of genome copies per milliliter in the case of positive detection.