Microsporidial myositis in adult-onset immunodeficiency: case-based review
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Polymyositis is a diagnosis of exclusion. In patients with odd features, it can be of infective etiology. A high index of suspicion is required for diagnosis. A 55-year-old gentleman presented with gradual-onset proximal muscle weakness. Examination revealed mild distal weakness but no rash. Muscle enzymes were raised and tests for autoantibodies were negative. Biopsy revealed microsporidiosis. In view of this unusual infection, immunodeficiency was considered and he was found to have lymphopenia which antedated his illness. Later, he developed cranial nerve palsies due to multiple lesions in the pons. In addition, he had Cytomegalovirus viremia. Literature was reviewed to identify 20 cases of microsporidial myositis, its presentation, underlying immunodeficient state, and clinical course. Infective polymyositis should be considered in a patient with paucity of clinical and serological autoimmune features. Lymphopenia can point to underlying immunodeficiency. CMV infection could be the contributor to or bystander-effect of idiopathic lymphopenia.
KeywordsMyositis Microsporidiosis Immunodeficiency Lymphopenia
Interstitial lung disease
- H. nana
Medical research council
Manual muscle testing
- FDG PET-CT
Fluorodeoxy glucose positron emission tomography–computed tomography
Gomori methenamine silver
Acid fast bacillus
Polymerase chain reaction
Human immunodeficiency virus
Acquired immunodeficiency syndrome
- P. jiroveci
Tumour necrosis factor
We would like to thank the Departments of Microbiology at Post-Graduate Institute of Medical Education and Research (PGIMER), Chandigarh for helping with the diagnosis and management of this challenging case.
Substantial contributions to the management of the case and design of this case-based review were made by all the authors. EKI and RSKM contributed in identifying the pathogenic organism. Drafting of the work and revising it critically was done by TGS, AA, SG and LG. Final approval of the version to be published was done by LG. All the authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
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