Severe polymyositis due to Toxoplasma gondii in an adult immunocompetent patient: a case report and review of the literature

Abstract

Toxoplasmosis, a worldwide zoonosis caused by a coccidian parasite Toxoplasma gondii, is more often asymptomatic in immunocompetent patients. We report the case of a 38-year-old immunocompetent male with a polymyositis as the presenting manifestation of T. gondii infection. The patient was hospitalized for a 30-day history of fever (T max 39.5°C), muscle pain, and progressive weakness of the muscles. A diagnosis of polymyositis was made, and he was started on corticosteroid treatment, which caused no reduction of symptoms. After finding a positive polymerase chain reaction (PCR) assay for T. gondii, together with additional clinical findings, a diagnosis of acute toxoplasmosis was made. Specific treatment with pyrimethamine and sulfadiazine was started, with a progressive reduction of symptoms and normalization of laboratory tests.

Diagnosis of toxoplasmosis and typing of Toxoplasma gondii

“…Primary infections in adults are mostly asymptomatic, but lymphadenopathy or ocular toxoplasmosis can present in some patients [ 5 ]. Severe acute, disseminated toxoplasmosis may occur in immunocompetent individuals when infected with some isolates [ 6 – 10 ]. Reactivation of a latent infection in immunocompromised individuals can cause fatal toxoplasmatic encephalitis, myocarditis and pneumonitis [ 11 , 12 ].…”

Secondary myopathy due to systemic diseases

“…Muscular sarcocystis is particularly prevalent in Malaysia . Other frequent protozoal infections with muscular involvement include toxoplasmosis and malaria . In toxoplasmosis, severe polymyositis may be even the presenting manifestation .…”

“…Other frequent protozoal infections with muscular involvement include toxoplasmosis and malaria . In toxoplasmosis, severe polymyositis may be even the presenting manifestation . In a patient with AIDS, myositis due to toxoplasmosis developed despite adequate antimicrobial treatment .…”

A fever of unknown origin as a presenting symptom in toxoplasmosis: Back to earth

“…However, after we made the diagnosis, we wondered whether our initial assumption was right. Very few healthy individuals who have been infected with Toxoplasma gondii become symptomatic, although fever and myalgia have been described as presenting symptoms, even in immunocompetent individuals [3,4].…”