Abstract
A 63-year-old man with B-cell acute lymphoblastic leukaemia on oral chemotherapy presented with fever and confusion after months of flu-like symptoms. Bloods showed pancytopenia with elevated inflammatory markers. Imaging showed pericardial and pleural effusions without pulmonary infection. The differential diagnosis included sepsis, drug effect, haemophagocytic lymphohistiocytosis and relapsed leukaemia. Broad spectrum antimicrobial therapy was commenced and bone marrow (BM) biopsy performed. Unfortunately, the patient deteriorated and suffered cardiac arrest secondary to tamponade. Despite open surgical drainage, he could not be resuscitated. The BM demonstrated histiocytes and granulocytes with crescent-shaped intracellular inclusions with prominent oval nuclei. Serology subsequently confirmed positive Toxoplasma IgM and IgG. Polymerase chain reaction was positive for Toxoplasma gondii. HIV serology was negative.
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