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The present article describes the clinical and pathological findings in 5 human immunodeficiency virus(HiV)-infected patients with muscle toxoplasmosis.The patients had marked lymphopenia(5/5),with less than five CD4=cells/mm3(3/3),when they developed fever(5/5),and multiorgan failure (5/5),including diffuse encephalitis,pneumonia,pancytopenia,and myopathy. Muscle involvement included weakness and wasting(4/5),myalgies(3/5),and high serum creatinine kinase levels(3/3).Serology for toxoplsmosis showed high IgG titers in 3 patients(3/4).Anti-Toxiplasma therapy resulted in complete recovery in 2 patients.Muscle toxoplasmosis was detected y biopsy 93/5)or postmortem evaluation(2/5),and was identified using immunocytochemistry and electron microscopy.Toxoplasma cysts were detected in 0.5 to 4%of muscle fibers close to or remote from nectrotic fibers and inflammatory infiltrates.Muscle fibers strongly expressed the major histocompatibility complex class I antigen(2/2)as in polymyositis.We suggest that Toxoplasma gondii should be sought by muscle biopsy in patients who have acquired immunodeficiency syndrome with fever, encephalitis,multiorgan dysfunction and elevated serum creatine kinase levels of obscure origin. |
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