Giardiasis as a cause of hypokalemic myopathy in congenital immunodeficiency

Abstract

Hypokalemic myopathy may occur in several infections. We report a case of severe and transient myopathy secondary to hypokalemia induced by chronic intestinal infection with Giardia lamblia in a patient with common variable hypogammaglobulinemia. Hypokalemic myopathy is documented by serum enzymes, electromyography (reduction in the number of voluntarily activated motor unit action potentials and an increase in polyphasic motor unit action potentials, and pathological changes (hematoxylin-eosin, ATPase staining). The case reported involves hypokalemic myopathy induced by giardiasis in a patient with primary immunodeficiency; the histopathological changes observed in a skin/muscle biopsy from this patient are described for the first time.

Changes in the Levels of Some Biochemical Parameters in the Serum of Children in Response to the Giardiasis Infection

“…In immunocompetent and immunocompromised patients, giardiasis has been reported to induce many cases of myopathy following hypokalemia (Cervello et al, 1993;Geovese et al, 1996). This leads to conclude that Giardia can work out of the control of the host's immune status by showing the ability to trigger muscular manifestations independently.…”

Malabsorption in Giardiasis

“…Several cases of myopathy following hypokalaemia induced by giardiasis have been reported with both immunocompromised and immunocompetent patients [44]. This suggests that giardia can trigger muscular manifestations independently to the immune status of the host.…”

“…This suggests that giardia can trigger muscular manifestations independently to the immune status of the host. During infection, potassium loss is related to number of bout of diarrhoea per day [44]. Hypokalaemia following bouts of diarrhoea is the trigger of transient myopathy.…”

Giardia

“…It has been proposed that increased intestinal permeability during G. duodenalis infection results in the increased uptake of food antigens, which in turn leads to the production of IgE an-tibodies to these antigens. The latter may contribute to the occurrence of urticaria and other skin disorders associated with giardiasis (Hamrick and Moore 1983;Di Prisco et al, 1993; (Farthing et al, 1983;Dos Santos and Vituri Cde, 1996;Canonne et al, 2000) Hypokalemia (Cervello et al,1993;Addiss and Lengerich, 1994;Genovese et al, 1996) Increased circulating IgE (Farthing et al, 1983;Di Prisco et al, 1993Perez et al, 1994;Pietrzak et al, 2005) This observation is further supported by studies demonstrating that G. duodenalis infection results in delayed local and sub-cutaneous mast cell hyperplasia (Hardin et al, 1997).…”

“…Arthalgia (Meza-Ortiz, 2001) Arthritis (Goobar, 1977) Hypokalemic induced myopathy (Cervello et al,1993;Genovese et al, 1996) Reactive arthritis (Woo and Panayi 1984;Layton et al, 1998;Letts et al, 1998;Tupchong et al, 1999;Carlson and Finger, 2004) …”