Dry J, Leynadier F, Henault S, Luboinski J, Niel G
Ann Med Interne (Paris). 1979;130(8-9):401-4.
Acute toxoplasmosis was diagnosed in a Japanese woman aged 31 years after the discovery of a raised lysis titre and agglutinins resistant to 2-ME, as well as early increases in specific IgM followed later by increases in specific IgG. A high fever was present and signs of mainly distal polymyositis. The muscle lesion was confirmed by EMG examination. No increase in muscle enzyme levels was noted at any stage of the disease. Muscle biopsy demonstrated inflammatory lesions in interstitial tissue and perimysium, and, more particularly, segmental necrotizing arteritis in several arterioles. All the arteriolar lesions were at the same stage of development. After prednisolone (60 mg/day) had failed to produce improvement, spiramycin was given and caused apyrexia in 48 hours and definite disappearance of all muscle signs within several days. Recovery was complete and there was no return of symptoms 18 months later. The authors discuss the association of acute toxoplasmosis, polymyositis, and necrotizing vasculitis, and suggest a possible pathogenic role for the immune complexes deposited on the arterial walls.
一名31岁的日本女性被诊断为急性弓形虫病，这是在发现其溶解效价升高且对2-巯基乙醇（2-ME）耐药的凝集素后，以及特异性IgM早期升高随后特异性IgG升高之后确诊的。患者出现高热，主要表现为远端多发性肌炎的体征。肌电图（EMG）检查证实了肌肉病变。在疾病的任何阶段均未发现肌肉酶水平升高。肌肉活检显示间质组织和肌束膜有炎症病变，更特别的是，在几条小动脉中有节段性坏死性动脉炎。所有小动脉病变均处于相同的发展阶段。在泼尼松龙（60毫克/天）治疗无效后，给予螺旋霉素，48小时内退热，数天内所有肌肉体征完全消失。患者完全康复，18个月后症状未复发。作者讨论了急性弓形虫病、多发性肌炎和坏死性血管炎之间的关联，并提出沉积在动脉壁上的免疫复合物可能具有致病作用。
