Introduction In Ireland, 75% of pregnant women are seronegative for toxoplasma, making them susceptible to primary infection during pregnancy.
First case: A female infant was conceived by IVF. Her mother received high dose steroids, humira and intravenous immunoglobulin at the initiation of, and during early pregnancy. The infant was neurologically abnormal at birth, had marked ventricular dilatation, intracranial calcification and bilateral retinal detachments. CT was confirmed with infant toxoplasma IgG and IgM positive. Maternal serology was consistent with primary maternal infection during pregnancy. Despite anti-toxoplasma therapy, the infant succumbed at six months of age.
Second Case: A one-year-old girl was investigated for a convergent strabismus. Conceived by IVF, her mother received high dose steroids for the first four months of pregnancy. Developmentally normal, at nine months of age she developed a right strabismus. Dilated fundoscopy revealed an extensive right macular scar. Neuroimaging showed intracranial calcification. Although toxoplasma IgM was negative, CT was diagnosed based on strongly persistent Toxoplasma IgG Ab, without evidence of decline over time. Developmental progress has been reassuringly appropriate. The macular scar is currently inactive.
Discussion The recognition of these two cases, one lethal infection in the setting of primary infection and one possible reactivation disease in women receiving immunosuppressive therapy to facilitate assisted reproduction raises a number of issues. Neither women were aware of toxoplasmosis, their toxoplasmosis status or measure to prevent its acquisition in pregnancy. Women under going immunosuppression in pregnancy should be aware of their status and advised regarding preventative measures.