Cuturic M, Hayat G R, Vogler C A, Velasques A
Department of Psychiatry and Neurology, Tulane University School of Medicine, New Orleans, LA, USA.
Neuromuscul Disord. 1997 Sep;7(6-7):390-6. doi: 10.1016/s0960-8966(97)00098-9.
Toxoplasmosis can cause polymyositis either by reactivation or by recent infection. Inconsistent response to antiprotozoal therapy has been the strongest argument against toxoplasmic polymyositis as a separate entity. We report a biopsy-proven case of toxoplasmic polymyositis in a cardiac transplant patient presenting with a severe proximal weakness, myopathic, electromyographic changes and ten-fold increase of anti-Toxoplasma antibodies. An early antiprotozoal therapy and plasmapheresis led to recovery. A review of previously reported cases of toxoplasmic polymyositis suggests that an early antiprotozoal therapy is the most important variable affecting the outcome of this disease. We propose that toxoplasmic polymyositis has two phases: acute, responsive to antiprotozoal therapy, and chronic, manifested by altered immune response requiring steroids. We suggest that all patients presenting with polymyositis should have serological tests for toxoplasmosis as a part of their initial evaluation and an early trial of antiprotozoal therapy in case of positive findings.
弓形虫病可通过复发或近期感染引发多发性肌炎。对抗原虫治疗反应不一，这是反对将弓形虫性多发性肌炎视为一个独立病种的最有力论据。我们报告了一例经活检证实的弓形虫性多发性肌炎病例，该病例为一名心脏移植患者，表现为严重的近端肌无力、肌病性肌电图改变以及抗弓形虫抗体升高了十倍。早期的抗原虫治疗和血浆置换导致病情恢复。对先前报道的弓形虫性多发性肌炎病例的回顾表明，早期抗原虫治疗是影响该病预后的最重要变量。我们提出，弓形虫性多发性肌炎有两个阶段：急性期，对抗原虫治疗有反应；慢性期，表现为免疫反应改变，需要使用类固醇。我们建议，所有出现多发性肌炎的患者在初始评估时都应进行弓形虫病血清学检测，若检测结果为阳性，则应尽早进行抗原虫治疗试验。
