title: Polyomyositis and myocarditis associated with acquired toxoplasmosis in an immunocompetent girl.
abstract: BACKGROUND
  Acquired toxoplasmosis more frequently goes unrecognized. Immunocompetent adults and adolescents with primary infection are generally asymptomatic, but symptoms may include malaise, fever, and lymphadenopathy. By contrast, immunocompromised patients may experience severe manifestations including encephalitis and multisystem organ failure.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Pediatrics, University General Hospital, University of Crete, School of Health Science, Greece. bellapas@yahoo.com
authors.forename: P K
authors.initials: PK
authors.lastname: Paspalaki
authors.forename: E P
authors.initials: EP
authors.lastname: Mihailidou
authors.forename: M
authors.initials: M
authors.lastname: Bitsori
authors.forename: D
authors.initials: D
authors.lastname: Tsagkaraki
authors.forename: E
authors.initials: E
authors.lastname: Mantzouranis