Gherardi R, Baudrimont M, Lionnet F, Salord J M, Duvivier C, Michon C, Wolff M, Marche C
Département de Pathologie, Hôpital Henri Mondor, Créteil, France.
Ann Neurol. 1992 Oct;32(4):535-42. doi: 10.1002/ana.410320409.
The present article describes the clinical and pathological findings in 5 human immunodeficiency virus (HIV)-infected patients with muscle toxoplasmosis. The patients had marked lymphopenia (5/5), with less than five CD4+ cells/mm3 (3/3), when they developed fever (5/5), and multiorgan failure (5/5), including diffuse encephalitis, pneumonia, pancytopenia, and myopathy. Muscle involvement included weakness and wasting (4/5), myalgias (3/5), and high serum creatine kinase levels (3/3). Serology for toxoplasmosis showed high IgG titers in 3 patients (3/4). Anti-Toxoplasma therapy resulted in complete recovery in 2 patients. Muscle toxoplasmosis was detected by biopsy (3/5) or postmortem evaluation (2/5), and was identified using immunocytochemistry and electron microscopy. Toxoplasma cysts were detected in 0.5 to 4% of muscle fibers close to or remote from necrotic fibers and inflammatory infiltrates. Muscle fibers strongly expressed the major histocompatibility complex class I antigen (2/2) as in polymyositis. We suggest that Toxoplasma gondii should be sought by muscle biopsy in patients who have acquired immunodeficiency syndrome with fever, encephalitis, multiorgan dysfunction, and elevated serum creatine kinase levels of obscure origin.
本文描述了5例感染人类免疫缺陷病毒（HIV）且患有肌肉弓形虫病患者的临床和病理表现。这些患者出现发热（5/5）和多器官功能衰竭（5/5，包括弥漫性脑炎、肺炎、全血细胞减少和肌病）时，均有明显的淋巴细胞减少（5/5），且CD4 +细胞/mm³少于5个（3/3）。肌肉受累表现为无力和消瘦（4/5）、肌痛（3/5）以及血清肌酸激酶水平升高（3/3）。弓形虫病血清学检测显示3例患者（3/4）的IgG滴度较高。抗弓形虫治疗使2例患者完全康复。通过活检（3/5）或尸检评估（2/5）检测到肌肉弓形虫病，并采用免疫细胞化学和电子显微镜进行鉴定。在靠近或远离坏死纤维和炎性浸润的肌肉纤维中，检测到0.5%至4%的弓形虫囊肿。与多发性肌炎一样，肌肉纤维强烈表达主要组织相容性复合体I类抗原（2/2）。我们建议，对于患有获得性免疫缺陷综合征且出现发热、脑炎、多器官功能障碍以及不明原因血清肌酸激酶水平升高的患者，应通过肌肉活检来查找弓形虫。
