Department of Anatomical Pathology, St. Vincent's Hospital Melbourne, P.O. Box 2900, Fitzroy 3065, Victoria, Australia.
J Clin Neurosci. 2013 Jul;20(7):1019-22. doi: 10.1016/j.jocn.2012.08.009. Epub 2013 May 7.
A new genus of nematode, Haycocknema perplexum, causing polymyositis in humans, was first described in two Australian patients from Tasmania in 1998. Three patients with myositis due to the same nematode were reported from northern Queensland in 2008. We report the sixth case from Australia, a 50-year-old man, also from Tasmania. He had a 2-year history of progressive weakness, weight loss of 10 kg and dysphagia. Muscle biopsy was initially interpreted as polymyositis with eosinophils. Maximum creatine kinase (CK) level was 5700 U/L and full blood examination was normal. He deteriorated after several months of treatment with prednisolone and methotrexate and review of the muscle biopsy showed intramyofibre parasites of H. perplexum. After 3 months of treatment with albendazole therapy, he made a very good clinical recovery and his CK decreased to 470 U/L. This uniquely Australian parasite can mimic polymyositis and leads to significant irreversible morbidity (two of the previous patients still have weakness and elevated CK after years) and even mortality (one died), if diagnosed late or after corticosteroids. Diagnosis can only be made by histopathology of muscle biopsy.
1998 年，在澳大利亚塔斯马尼亚的两名患者中首次发现了一种新的线虫属——海氏线虫属（Haycocknema），该线虫可引起人类多发性肌炎。2008 年，来自昆士兰北部的三名肌炎患者也被报告患有这种线虫引起的肌炎。我们报告了来自澳大利亚的第六例病例，一名 50 岁的男子，同样来自塔斯马尼亚。他有 2 年进行性无力、体重减轻 10 公斤和吞咽困难病史。肌肉活检最初被解释为伴有嗜酸性粒细胞增多的多发性肌炎。肌酸激酶（CK）最高值为 5700U/L，全血细胞检查正常。在接受泼尼松龙和甲氨蝶呤治疗数月后病情恶化，并且对肌肉活检的复查显示 H. perplexum 寄生在肌纤维内。在接受阿苯达唑治疗 3 个月后，他的临床状况得到了非常好的恢复，CK 降至 470U/L。这种独特的澳大利亚寄生虫可以模拟多发性肌炎，并导致显著的不可逆转的发病率（以前的两名患者在数年后仍有无力和 CK 升高），甚至死亡（一名患者死亡），如果诊断较晚或在使用皮质类固醇后。诊断只能通过肌肉活检的组织病理学来做出。
