Toxoplasmosis-Associated Hemophagocytic Lymphohistiocytosis in a Liver Transplant Recipient

Toxoplasmosis is a rare parasitic infectious disease in solid organ transplant recipients. The disease is characterized by difficulties in diagnosis and high mortality. However, there have been no reported cases of hemophagocytic lymphohistiocytosis (HLH) caused by toxoplasmosis in liver transplant patients. Here, we present the case of an adult female liver transplant recipient who experienced a fatal outcome and developed secondary HLH following confirmation of toxoplasmosis through metagenomic next-generation sequencing. The patient exhibited symptoms, including high fever, skin rash, unconsciousness, and multiorgan failure. The condition met six out of eight criteria for HLH according to the HLH-2004 diagnostic criteria. Additionally, the H-score for this patient was 287 points, confirming the diagnosis of HLH. This represents the first reported case of toxoplasmosis-associated secondary HLH in an adult liver transplant recipient in China.