Document 0189
 DOCN  M9460189
 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

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