Journal of Clinical Neuroscience xxx (2013) xxx–xxx
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Case Report
A further patient with parasitic myositis due to Haycocknema perplexum, a rare entity Penelope McKelvie a,⇑, Katrina Reardon b, Katherine Bond c, David M. Spratt d, Andrew Gangell e, Jane Zochling f, John Daffy c a
Department of Anatomical Pathology, St. Vincent’s Hospital Melbourne, P.O. Box 2900, Fitzroy 3065, Victoria, Australia Department of Clinical Neuroscience, St. Vincent’s Hospital Melbourne, Victoria, Australia Department of Infectious Diseases, St. Vincent’s Hospital Melbourne, Victoria, Australia d Australian National Wildlife Collection, CSIRO Ecosystem Sciences, Canberra, Australian Capital Territory, Australia e Sorell Family Practice, Sorell, Tasmania, Australia f Menzies Research Institute, University of Tasmania, Hobart, Tasmania, Australia b c
a r t i c l e
i n f o
Article history: Available online xxxx Keywords: Dysphagia Haycocknema perplexum Parasitic myositis Severe muscle weakness
a b s t r a c t A new genus of nematode, Haycocknema perplexum, causing polymyositis in humans, was first described in two Australian patients from Tasmania in 1998. Three patients with myositis due to the same nematode were reported from northern Queensland in 2008. We report the sixth case from Australia, a 50year-old man, also from Tasmania. He had a 2-year history of progressive weakness, weight loss of 10 kg and dysphagia. Muscle biopsy was initially interpreted as polymyositis with eosinophils. Maximum creatine kinase (CK) level was 5700 U/L and full blood examination was normal. He deteriorated after several months of treatment with prednisolone and methotrexate and review of the muscle biopsy showed intramyofibre parasites of H. perplexum. After 3 months of treatment with albendazole therapy, he made a very good clinical recovery and his CK decreased to 470 U/L. This uniquely Australian parasite can mimic polymyositis and leads to significant irreversible morbidity (two of the previous patients still have weakness and elevated CK after years) and even mortality (one died), if diagnosed late or after corticosteroids. Diagnosis can only be made by histopathology of muscle biopsy. Ó 2012 Elsevier Ltd. All rights reserved.
1. Introduction A new genus of nematode, Haycocknema perplexum, causing polymyositis in humans was first described in two Australian patients from Tasmania in 1998.1,2 Ten years later, another three patients with myositis due to the same nematode were reported from northern Queensland.3 We report the sixth case from Australia, a 50-year-old man, also from Tasmania.
2. Clinical features A 50-year-old Caucasian shipwright presented in December 2010 with a several year history of weakness and weight loss. He had no significant past medical history. In 2008, he first noticed difficulty running up stairs. This weakness progressed over the next 2 years. He also noticed intermittent problems with swallowing, and lost approximately 10 kg. On presentation to his general practitioner in December 2010, there were no objective clinical ⇑ Corresponding author. Tel.: +61 3 9288 4558; fax +61 3 9288 4580. E-mail address:
[email protected] (P. McKelvie).
findings. The only abnormal investigation was an elevated serum alanine transferase concentration (ALT) of 92 U/L (normal range < 41 U/L). ALT had been elevated since 2004, with a maximum of 152 U/L in 2008. Full blood count, including eosinophils was normal. His C-reactive protein concentration was
