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Juvenile Dermatomyositis Induced by Toxoplasmosis

Department of Pediatrics, University of Calgary Faculty of Medicine

Harvey B. Sarnat, MD, FRCP(C)

Department of Pediatrics, University of Calgary Faculty of Medicine, Department of Pathology, University of Calgary Faculty of Medicine, Department of Clinical Neurosciences, University of Calgary Faculty of Medicine, Calgary, Alberta, Canada

David S. Matheson, MD, FRCP(C)

Department of Pediatrics, University of Calgary Faculty of Medicine

T. Peter Seland, MD, FRCP(C)

Department of Clinical Neurosciences, University of Calgary Faculty of Medicine, Calgary, Alberta, Canada

A 10-year-old girl from southern Alberta, Canada, who had close contact with cats, developed typical features of dermatomyositis. The diagnosis was confirmed by muscle biopsy. A toxoplasmosis titer was 1:16,384 by indirect fluorescent antibody technique, and the IgM response to toxoplasma was positive. Only minimal improvement followed prednisone and azathioprine administration, but she rapidly improved after 4 weeks of treatment for toxoplasmosis with pyrimethamine and sulfadiazine. A year after the onset of dermatomyositis, she showed no weakness or cutaneous lesions, and a repeat muscle biopsy no longer showed inflammation, perifascicular atrophy, or regeneration of myofibers. She remains asymptomatic more than 2 years after discontinuation of all medications. Investigation for immune deficiency disease 1 year after therapy revealed that lymphocytic response to T-cell and B-cell mitogens was normal, as were immunoglobulin and complement levels. She had mild impairment of natural killer cell activity and a positive antinuclear factor. Her rapid improvement on specific therapy and lack of significant long-term immune deficiency is consistent with acute toxoplasmosis infection in an immunologically competent child. (J Child Neurol 1987;2:101-104).

Journal of Child Neurology, Vol. 2, No. 2, 101-104 (1987)
DOI: 10.1177/088307388700200204


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