Woman with bilateral painful lower limb swelling: Case report of an atypical presentation of toxoplasmosis in immunocompetent adult

A 43 year old previously healthy woman presented with painful bilateral lower limb swelling for 3 weeks, and fever and polyarthralgia of 3 days duration. She had a history of close contact with cats. Examination revealed moderate hepatomegaly with severe muscle tenderness. She had eosinophilia and elevated creatinine kinase and lactate dehydrogenase. Results of her toxoplasmosis serology were consistent with acute toxoplasmosis. Immunosuppressive conditions were excluded. Bone marrow biopsy revealed marked eosinophilia. According to these findings she was diagnosed as having acute toxoplasmosis complicated with myositis. This was further strengthened by her response to pyrimethamine and sulfadiazine treatment.