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Toxoplasmic encephalitis during mycophenolate mofetil immunotherapy of neuromuscular disease Objective: To show that immunotherapy with medications such mycophenolate mofetil (MMF) can cause serious complications in patients with neuromuscular disorders. Methods: Two patients with neuromuscular disorders on immunotherapy with long-term MMF who developed toxoplasmic encephalitis (TE) were included in this case series. Results: One patient with myasthenia gravis and one patient with inflammatory myopathy on immunotherapy with long-term MMF developed severe TE. Diagnosis was based on clinical pre-sentation, MRI brain imaging characteristics, and CSF PCR positivity for Toxoplasma gondii. Both patients were treated with pyrimethamine, sulfadiazine, and leucovorin for 2 months without clinical improvement, and both died. Conclusions: Immunotherapy with medications such asMMF can cause devastating TE in non-HIV patients with neuromuscular disorders. Early consideration and recognition of this complication is important to possibly prevent unfavorable outcomes. The utility of screening and prophylaxis against toxoplasmosis in individuals with neuroimmunologic disorders and other autoimmune dis-orders who receive immunosuppressive therapy requires future study. Neurol Neuroimmunol Neuroinflamm 2015;2:e63; doi: 10.1212/NXI.63 GLOSSARY Ig 5 immunoglobulin;MMF 5 mycophenolate mofetil;MPA 5 mycophenolic acid;MS 5 multiple sclerosis; TE 5 toxoplasmic encephalitis; TMP-SMX 5 trimethoprim/sulfamethoxazole; WBC 5 white blood cell. Mycophenolate mofetil (MMF) is increasingly used in the treatment of neuromuscular autoim-mune diseases such as myasthenia gravis. Toxoplasma gondii encephalitis occurs most often in AIDS patients and posttransplantation and rarely is reported as a complication of immunosup-pressive treatment of autoimmune disease. No previous cases of toxoplasmic encephalitis (TE) occurring in association with MMF in the treatment of neuromuscular autoimmune disease have been reported. We report 2 cases of TE associated with immunosuppressive treatment of neuromuscular disease with long-term MMF therapy. METHODS This article describes 2 patients with neuromuscular disorders on immunotherapy with long-termMMF who developed TE