Toxoplasma gondii is a very hostile and exceptionally common intracellular protozoan parasite with one of the highest infestation rate among world’s population Fong MY,2010Taila et al., 2011. Transmission of T. gondii starts by ingestion of infected food or contaminated water containing cysts of the parasite, it can be transmissible through blood transfusion and organ transplant Masters, 2015Taila et al., 2011. However, in healthy subjects the infection is generally asymptomatic and can remain silent for years Fong MY, 2010. Manifested symptoms are similar to those of different infectious diseases such as EBV, varicella, mononucleosis, cytomegalovirus, cat scratch disease or leishmaniaisis and can include lymphadenopathy, fever, fatigue, muscle pain, sore throat and headache Fong MY, 2010. In pregnant women, toxoplasmosis can be of serious risks of malformation to fetus, neurological impairment, impaired vision even death Fong MY, 2010. In immunosuppressed individuals, the infection may trigger secondary disseminated infection in system leading to death Fong MY, 2010. Cutaneous manifestation of toxoplasmosis, however, is rarely encountered Fong MY,2010. Clinical presentation of T. gondii infection varies with the age and immune status of the patient. Roughly 10% of immune competent patients develop a non-specific and self-limiting illness most typically characterized by isolated cervical or occipital lymphadenopathy that may persist for less than four to six weeks Taila et al., 2011. The lymph nodes are usually unnoticeable, non-tender and are not exclusive for T. gondii diagnosis Fong MY, 2010Masters, 2015Taila et al., 2011. Rarely immune competent patients may develop some form of secondary infection such as myocarditis, polymyositis, pneumonitis, hepatitis, or encephalitis Fong MY, 2010Hoffman A, 2008Masters, 2015Taila et al., 2011. In general, after the acute phase, the infection will remain latent due to the presence of cysts within the tissues which does not manifest clinical symptoms Taila et al., 2011. Conversely, for immunocompromised patients, such as with HIV or common variable immunedeficiency (CVID) this parasite can be a serious life-threatening pathogen Porter and Sande, 1992. In this population, toxoplasmosis arises consequently to a reactivation of subtle chronic condition often affecting the central nervous system (CNS) Mrusek et al., 2004Porter and Sande,1992Shachor et al., 1984. T. gondii infection can be diagnosed via different types of screening, directly via polymerase chain reaction (PCR), hybridization, isolation, and histology and indirectly via serological methods Fong MY, 2010Hoffman A, 2008Liesenfeld et al., 2001Masters, 2015Mrusek et al., 2004Porter and Sande, 1992Shachor et al., 1984Taila et al., 2011. Immunocompetent patient are usually tested by indirect serological methods as it is faster and readily available; however, it is highly recommended that this screening for asymptomatic immunocompromised patients as well, for IgG antibodies to T. gondii, as this allows to recognize recurrence of latent infection Liesenfeld et al., 2001. It is generally accepted that the presence of high avidity antibodies is likely to indicate a more recent infection which might be happened during a period of past three to four months; on the other hand, low avidity antibodies tend to be present well after three months of infection indicating a past acquired infection Liesenfeld et al., 2001. PCR amplification of T. gondii genes (specifically, the B1 gene) can be performed on both fluids and tissue samples, which in optimal storage and handling condition would give a sensitivity rate no greater than 50% but would be highly specific Angel SO, 1997. Conventional therapy depends on immunity state of the patient. Pyrimethamine, sulfadiazine and folinic acid are usually used for both immunocompromised patients and immunocompetents with severe or recurrent signs of the infection Torre D, 1998. Duration of treatment varies from two to four months, depending on clinical signs and symptoms Torre D, 1998. Protocol indicates maintenance therapy to be commenced after the acute phase and should be based on half dose medication used during the acute phase. Kaplan and colleagues have suggested that this therapy should be continued until symptoms and immunology responses are resolved. Particular cases such as in HIV infected patients the therapy should be continued for the life Masur, 2002. Diabetes is a life persistent disorder affected by daily food intake, life-style, genetic predisposition, infection (Coxsackie B4 virus) and stress Shivanshankar M, 2011. The genetic element has been traced to particular HLA genotypes known as genetic "self" identifiers that closely depend on the immune system Shivanshankar M, 2011. It is a metabolic disorder characterized by high blood glucose accompanied by insulin resistance and relative insulin deficit Shivanshankar M, 2011. At the initial onset of the disease DM is managed by increasing exercise and diet, however over the time the condition steadily progresses thus medications are needed to control the elevation incidence of blood sugar Shivanshankar M, 2011. Cardiovascular diseases, ulcerative lesions, retinopathies and kidney failures are long-term complications from high blood sugar Shivanshankar M, 2011.

An 83-year-old lady, on cholesterol, blood pressure and diabetic type 2 medications, presented to her primary care physician with a history of persistent erythema and urticaria since few months. It was found that for one month prior to presentation, the patient hadnoticed multiple enlarged skin red patches, with small varicella like eruptions largely disseminated, no lymph nodes enlargement were noted. Patient was of South America heritage, but raised in the USA since her early 20’s. She had not had contact with infected individuals nor had she had any occupational exposure. A series of constitutional symptoms were reported such as constant diarrhea accompanied by constipation, blurry vision, mental and physical debilitation. A panel test was performed for the presence of Strongyloides stercoralis, Gnothostoma and Toxocara with negative results. CBC test revealed Lymphopenia 1,29 10³/mm³ (normal range 1.50-4.00 mm³). Given these findings, the primary care physician prescribed a course of antihistaminic medication Telfast and Aerius for a total period of 4 months without valuable results.

Thus, the patient came to our clinic for re-evaluation. Symptoms got worse with more intense pruritus that increased during night time. On physical examination, the patient was afebrile with normal vital signs, abdomen was bloated and distended, lower right and left quadrant were sensitive on palpation, the entire body presented with round and elongated swollen reddish-pink patches extremely itching accompanied with small varicella like eruptions. This patient was clear and cognitively alert. A monospot VZV-DNA PCR test was performed and resulted negative for Varicella Zoster virus infection. Upon more thorough investigation, the patient indicated that approximately every day she was eating a diet rich in meat, starches and carbohydrates. Additional laboratory studies were ordered and showed a mild high Neutrophilia 75.1 % (normal range 45-70%), high Acid uric umol/L (normal range 150-420 umol/L), high Glucose 7.36 mmol/l (normal range 3.9-6.4 mmol/l) low Testosterone 0.139 ng/ml (normal range female 014-1.2 ng/ml), low globulin 24.2 g/l (normal range 25-35 g/l), Folate at limit low 7.3 ng/ml (normal range 3.1-20 ng/ml) and low Vitamin D 37.6 ng/ml (normal range 30-150 ng/ml), HbA1c 5.5% (normal range 4.1-6.5%), Glucose 7.36 mmol/L (normal range 3.9-6.4 mmol/L), C peptide 0.312 mmol/L (normal range 0.2-0.6 mmol/L), Insulin 8.12 mUI/L (normal range <20 mUI/L). At the moment of the visit she was under the antihistaminic medication Telfast and Aerius, Trajenda 5mg for diabetes, Lipitor 20 mg, Co.Diovan 80/12.5 mg, Herbesser R100 100mg and Aspirin 81mg. The patient was diagnosed with a non-specific chronic/acute allergic reaction and counseled regarding dietary habits and risk factors. A specific low glycemic index diet was suggested, and in accordance with the patient treatment with autologous PB-SCs were administered to ensure resolution of allergic/intolerance reaction. At the end of the treatment clinical symptoms as itching and erythematous rashes drastically decreased by 80%, her general health state improved and she was back to a normal active life. Immediately after the treatment we decided to perform a a new panel screen for parasite infestation by Elisa and, with our surprise results showed IgM negative and IgG positive with OD 1.319 for T gondii which confirmed that the patient has been recently infected, a month later the results showed negative for T gondii. RT-PCR has been performed on blood sample twice and results confirmed negative for T gondii infection. By the end of June diabetes marker levels revealed HbA1c 6%, C peptide 1.04 mmol/L, Glucose 5.95 mmol/L, Insulin 11.32 uU/ml. Additional test have been performed on her blood and stem cells after the treatment, by using Flow-cytometry (BD.FACS Canto II, 2-laser, 6-color) to assess her lymphocytic activity such as T cells CD3-CD4-CD8, B cells CD19, NK cells CD56-CD16, CD45, CD34 and CD14 ( Figure 1 , and Figure 2 ; and Table 2 , and Table 3 ).

Written informed consent was obtained from the patient for publication of this case report. A copy of the written consent is available for review by the Editorin- Chief of this journal.