Table I.

Cerebral toxoplasmosis in patients treated with rituximab

Study	Patient descriptor	Relevant medications	Onset	Presentation	Outcome
Desmond et al, 20094	63 M with CLL	Fludarabine, cyclophosphamide, and rituximab	8 mo following rituximab treatment	Apraxia, forgetfulness, and cognitive impairment	Incidental finding of toxoplasmosis along with PML; died 4 wk after diagnosis
Safa and Darrieux, 20135	71 F with cutaneous necrotizing vasculitis associated with essential cryoglobulinemia	Prednisone, methylprednisolone, azathioprine rituximab (1 cycle, 375 mg/m2 weekly for 4 weeks)	4 mo following rituximab treatment	Speech disturbance, behavioral changes, weight loss	No improvement of mental status following treatment with pyrimethamine, sulfadiazine sodium, and folinic acid
Savsek and Opaskar, 20166	62 F with DLBCL	2 cycles of rituximab and chlorambucil 8 cycles of R-CHOP	5 d following 8 cycles of R-CHOP	High fever, headache, altered mental status, pancytopenia	Mild cognitive defects persistent after 6 wk of treatment with sulfadiazine, pyrimethamine, and folic acid Maintenance therapy with rituximab was subsequently restarted
Gharamti et al, 20187	65 F with pseudolymphoma	Abatacept 6 cycles of bendamustine and rituximab Trametinib	5 wk after trametinib therapy	Gait incoordination, fine motor skill difficulties	Substantial clinical improvement and reduction in CNS lesions following 16-wk treatment with TMP-SMX
Current study	52 F with PV	MMF 3 cycles of rituximab	6 wk after 3rd cycle of rituximab	Rhinorrhea (CSF leak with encephalocele)	Clinical improvement and reduction in CNS lesions following treatment with pyrimethamine, sulfadiazine, and folinic acid, followed by prophylaxis. Follow-up brain MRI after treatment showed the lesion decreasing in size, most recently at 5 mm. Previously measured to be 7 mm prior to treatment.

CLL, Chronic lymphocytic leukemia; DLBCL, diffuse large B cell lymphoma; R-CHOP, rituximab, cyclophosphamide, vincristine, doxorubicin, and prednisolone.