Toxoplasma gondii pneumonia in a pancreas transplant patient.

A 41-year-old woman had fever of 3 days' duration. She had had pancreas transplantation 2 years previously and had recently completed a course of antirejection medication. Temperature spikes occurred during treatment with broad spectrum antibiotics. No obvious cause for the fever was found. The patient's condition worsened, with development of shortness of breath, bilateral pulmonary infiltrates on chest radiographs, sepsis, and shock. Fiberoptic bronchoscopy with bronchoalveolar lavage showed the presence of Toxoplasma gondii. Pyrimethamine and clindamycin were started, and the patient improved. Toxoplasma gondii occurs in contaminated food containing oocysts or cysts. Organ transplantation and blood transfusions are other routes of transmission. Most recent cases have occurred in human immunodeficiency virus (HIV) patients with reactivation of previous infection. Serology and tissue biopsies are used for diagnosis. Treatment includes a combination of pyrimethamine and sulfadiazine or trisulfapyrimidines.