Lindsey Tyrrell · Prevention of Future Deaths report

On 13th July 2017, an investigation was commenced into the death of Lindsey Tyrrell who died at the Christie Hospital, Withington, Manchester on 3rd July 2017 She was 41 years of age I concluded the Inquest on 28th June 2018

I found the following as the medical cause of death -

1a Fulminant central nervous system toxoplasmosis
1b Immunosuppression
1c Treated B-cell Acute Lymphoblastic Leukaemia

My conclusion was -

Narrative Complications, namely an untreated infection which remained unidentified prior to death, arising from necessary lifesaving medical treatment

In November 2014, Mrs Tyrell was diagnosed with B-cell Acute Lymphoblastic Leukaemia ('B-ALL') She was commenced on intensive chemotherapy which she tolerated well She achieved complete remission of her disease and was moved to maintenance therapy in September 2015

Unfortunately, in December 2016, it was noted that her bloods were deteriorating and marrow investigations revealed a relapse of her B-ALL At that stage, the only prospect for long term survival was an allogeneic stem cell transplant

Accordingly, on 24th March 2017, Mrs Tyrell underwent an unrelated donor stem cell transplant She received appropriate immunosuppressive treatment and was therefore at high risk of developing an infection over the next 12 months

At the beginning of June 2017, Mrs Tyrell presented at the Christie Hospital with headaches, a fever and an intermittent rash She had clearly developed an infection by that point Investigations were carried out to identify the nature of the infection However, no evidence of infection was found on routine blood testing She was also routinely scanned for evidence of infection in her brain but nothing abnormal was noted

Mrs Tyrell continued to deteriorate On 21st June a lumbar puncture test was performed but no infection was found in the cerebrospinal fluid ('CSF')

Over the course of 27th June to 29th June, there was a significant deterioration in Mrs Tyrell's condition and by 30th June, the prognosis was terminal She passed away on 3rd July 2017

Following her death, the Christie Hospital reanalysed the bloods taken during the course of Mrs Tyrell's last admission to hospital It was found that her blood samples from 5th June 2017 onwards tested positive for toxoplasma The CSF from 21st June was also retested and found to be positive for toxoplasma

1 I heard evidence at the Inquest that toxoplasmosis is carried by about 30% of the population, however, prior to Mrs Tyrell's death testing for this infection was not routinely carried out at the Christie Hospital on patients who had received an allogeneic stem cell transplant and who had subsequently presented with signs of infection I heard evidence that, following Mrs Tyrell's death, testing for toxoplasmosis is now undertaken at the Christie Hospital when stem cell transplant patients present in similar circumstances However, there was no evidence before me as to the practice of other specialist blood cancer care units or hospitals in similar circumstances It seems appropriate that the learning from this incident at a local level should be shared on a nationwide basis