Key result
Prednisolone resolves toxoplasmosis-associated polymyositis and myocarditis without relapse over ~4 years in a pediatric case.
Why the study?
Acquired toxoplasmosis is often unrecognized in immunocompetent individuals, and its association with polymyositis and myocarditis is unusual and not well understood.
Case Report (n=1)
No
This case highlights that acquired toxoplasmosis can present with severe manifestations like polymyositis and myocarditis even in immunocompetent adolescents, and may respond well to prednisolone.
Toxoplasma may cause myocarditis in immunocompetent adolescents; leaves open whether serologic testing belongs in the differential for unexplained cases.
BACKGROUND: Acquired toxoplasmosis more frequently goes unrecognized. Immunocompetent adults and adolescents with primary infection are generally asymptomatic, but symptoms may include malaise, fever, and lymphadenopathy. By contrast, immunocompromised patients may experience severe manifestations including encephalitis and multisystem organ failure. CASE PRESENTATION: We report a case of polymyositis and myocarditis in a 13-year old immunocompetent girl with toxoplasmosis. The patient presented with proximal muscle weakness, dysphagia, palms and soles rash and elevated serum levels of muscle enzymes, with liver and myocardial involvement. The diagnosis of toxoplasmosis was confirmed by serology. The patient was treated with prednisolone and had an excellent outcome. During a follow-up period of four years no relapses occurred and antibody levels to the T. gondii significantly decreased. CONCLUSIONS: Although several previous cases of toxoplasmosis occuring in association with polymyositis have been described in the literature such a wide spectrum of acute toxoplasmosis is rather unusual in immunocompetent adolescents. The relationship between T. gondii and polymyositis remains obscure. Appropriate investigation should be performed in every case of polymyositis not only for the appropriate treatment but also for further elucidation of this relationship.
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Paspalaki et al. (2001) conducted a case report in Acquired toxoplasmosis with polymyositis and myocarditis (n=1). Prednisolone was evaluated on Clinical and laboratory recovery. Prednisolone treatment resulted in complete clinical recovery without relapses over a four-year follow-up in an immunocompetent girl with toxoplasmosis-associated polymyositis and myocarditis.
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