Document Type : Case Report
Authors
1
Department of Medical Parasitology and Mycology, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
2
Department of Internal Medicine, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran.
3
Department of Medical Microbiology and Immunology, School of Medicine, Qom University of Medical Sciences, Qom, Iran.
4
Iranian National Registry Center for Lophomoniasis and Toxoplasmosis, Imam Khomeini Hospital, Mazandaran University of Medica l Sciences, Sari, Iran .
5
Toxoplasmosis Research Center, Communicable Diseases Institute, Department of Parasitology, Mazandaran University of Medical Sciences, Sari, Iran.
6
North Research Center, Pasteur Institute of Iran, Amol, Iran.
7
Iranian National Registry Center for Lophomoniasis and Toxoplasmosis, Imam Khomeini Hospital, Mazandaran University of Medical Sciences, Sari, Iran.
8
Department of Parasitology and Mycology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.
Abstract
Pulmonary toxoplasmosis is a rare but potentially fatal opportunistic infection, most
often reported in HIV-infected individuals. Its occurrence in non-HIV
immunocompromised patients—particularly those with hematologic malignancies like
multiple myeloma (MM)—is exceedingly rare and diagnostically challenging due to
nonspecific clinical and radiologic features. While Toxoplasma gondii infection is
typically mild in immunocompetent hosts, it can cause severe disease in
immunocompromised populations. A literature review was conducted using PubMed,
Scopus, and Google Scholar (January 2000–May 2025) with keywords: ‘pulmonary
toxoplasmosis,’ ‘multiple myeloma,’ ‘non-HIV,’ ‘immunocompromised,’ and ‘BAL
PCR.’ Only English-language case reports and reviews were included, with emphasis on
studies from endemic regions and the past five years. We report a 49-year-old Iranian
man with newly diagnosed IgG kappa MM who presented with fever, chills, vomiting,
and dyspnea. Chest CT revealed a 4.2 × 3.8 cm consolidation in the posterior segment
of the right lower lobe. T. gondii infection was confirmed via bronchoalveolar lavage
(BAL) through tachyzoite detection on Giemsa stain and molecular identification using
qPCR and nested PCR targeting the Gra6 gene. He showed transient clinical
improvement and was discharged on hospital day 7. Unfortunately, he died at home
within 48 hours due to MM progression, before anti-toxoplasmosis therapy was initiated.
This case underscores the diagnostic difficulty of pulmonary toxoplasmosis in non-HIV
immunocompromised patients and the importance of molecular BAL testing.
Prophylactic measures such as co-trimoxazole should be considered in high-risk MM
patients. Guidelines must address screening and management in this vulnerable
population.
Keywords