Polyomyositis and myocarditis associated with acquired toxoplasmosis in an immunocompetent girl

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.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.Toxoplasma gondii is the most common cause of protozoan infections in humans. Cats are the definitive hosts which produce oocysts and sporozoites. Ingestion by a nonfeline leads to the formation of tachyzoites and further dissemination with the formation of cysts in skeletal muscle, heart muscle and central nervous system (CNS). The acquired disease can be transmitted in humans by ingestion of tissue cysts in inadequately cooked meat or by ingestion of uncooked food that have come in contact with contaminated meat. The infection is usually asymptomatic, however clinical manifestations do occur, ranging from mild, nonspecific febrile illness and lymphadenopathy to systemic disease in immunocompromised patients [1-3]. The severe form of the disease may present with muscle, heart, liver and central nervous system involvement. Significant organ involvement in immunocompetent individuals is uncommon but some individuals have suffered significant morbidity [1,2].Acquired toxoplasmosis has been associat